hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|GA,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."
"Effingham Health System",9/21/2026,3.0.0,"Effingham Health System","459 GA-119 Springfield, GA 31329",,51236,,TRUE
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"#1 Salivary Cortisol LC",22502125,CDM,300,RC,82533,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.08,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.08,177.65,
"#2 Salivary Cortisol LC",22502127,CDM,300,RC,82533,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9.17,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.17,177.65,
"#3 Salivary Cortisol LC",22502129,CDM,300,RC,82533,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.82,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.82,177.65,
"#4 Salivary Cortisol LC",22502131,CDM,300,RC,82533,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.82,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.82,177.65,
".AFB ID by DNA Probe LC",2287149,CDM,300,RC,87149,HCPCS,"OUTPATIENT ",,,143,,,95.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",128.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.52,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",40.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",135.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",121.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.52,135.85,
".Dexamethasone, Serum LC",22500118,CDM,300,RC,80299,HCPCS,"OUTPATIENT ",,,401,,,268.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",360.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.52,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",112.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",340.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.14,380.95,
".dRVVT Confirm 117923 LC",2285613,CDM,300,RC,85613,HCPCS,"OUTPATIENT ",,,28.8,,,19.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",25.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.52,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",24.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.06,27.36,
".dRVVT Mix LC",2285613,CDM,300,RC,85613,HCPCS,"OUTPATIENT ",,,28.8,,,19.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",25.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",24.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.06,27.36,
".Glucose Fasting",2282947,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 1 HR",2272951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",62.29,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,62.29,
".GTT 1 HR 100gm",2272951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",62.29,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,62.29,
".GTT 1 HR 50gm",2272951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 1 HR 75gm",2272951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 1 HR PP",2272951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.04,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 2 HR",2262951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.04,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 2 HR 100gm",2262951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.37,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 2 HR 75gm",2262951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 2 HR PP",2262951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 3 HR",2252951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 3 HR 100gm",2252951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 3 HR 75gm",2252951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 4 HR",2242951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.65,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 4 HR 100gm",2242951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 4 HR 75gm",2242951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.99,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 5 HR",2232951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.99,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 5 HR 100gm",2232951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.34,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".GTT 5 HR 75gm",2232951,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.34,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
".HCV Qn Interp LC",2287522,CDM,306,RC,87522,HCPCS,"OUTPATIENT ",,,718.45,,,481.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",646.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",203.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",201.17,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",682.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",610.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges",431.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",21.69,682.53,
".HCV RT-PCR,Quant(Non-Graph) LC",2287522,CDM,306,RC,87522,HCPCS,"OUTPATIENT ",,,718.45,,,481.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",646.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.94,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",203.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",201.17,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",682.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",610.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges",431.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.94,682.53,
".IGP, rfx Aptima HPV ASCU LC",2288175,CDM,301,RC,88175,HCPCS,"OUTPATIENT ",,,123,,,82.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.38,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",110.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.94,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",116.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",33.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",104.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.94,116.85,
".Manual Differential (EFMC)",2285007,CDM,305,RC,85007,HCPCS,"OUTPATIENT ",,,4.75,,,3.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.33,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.73,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,4.65,4.65,4.65,"1 through 10",other,"not separately reimbursment",1.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.33,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",1.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",4.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",1.33,18.5,
".Org ID by Seq LC",2287153,CDM,306,RC,87153,HCPCS,"OUTPATIENT ",,,203.63,,,136.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",97.38,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",183.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",193.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",173.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.51,193.45,
".Post TR ABO/Rh",2286900,CDM,302,RC,86900,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,48.68,15.89,81.47,"1 through 10",other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.75,115.43,
".Post TR Antibody Screen Gel",2286850,CDM,302,RC,86850,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.23,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,37.73,37.73,37.73,"1 through 10",other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.23,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.53,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.53,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14,47.5,
".Post TR Crossmatch",2286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
".Post TR DAT IgG Tube",2286880,CDM,302,RC,86880,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.75,57,
".Post TR DAT Poly Tube",2286880,CDM,302,RC,86880,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.75,57,
".RPR Qn LC",2286593,CDM,302,RC,86593,HCPCS,"OUTPATIENT ",,,134.42,,,90.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.05,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",120.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",127.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",114.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",80.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.05,127.7,
".Thyroglobulin by IMA LC",2284432,CDM,301,RC,84432,HCPCS,"OUTPATIENT ",,,56.64,,,37.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",50.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.84,53.81,
".Thyroglobulin by LCMS LC",2284432,CDM,301,RC,84432,HCPCS,"OUTPATIENT ",,,56.64,,,37.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",50.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.84,53.81,
".Thyroglobulin by RIA LC",2284432,CDM,301,RC,84432,HCPCS,"OUTPATIENT ",,,56.64,,,37.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",50.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.75,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.75,53.81,
".TR Interpretation",2286077,CDM,302,RC,86077,HCPCS,"OUTPATIENT ",,,285,,,190.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",79.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",79.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",256.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.75,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",80.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",79.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",270.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",45.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",242.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",79.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",171,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.75,270.75,
".Ur Microscopic 333328 LC",2281015,CDM,302,RC,81015,HCPCS,"OUTPATIENT ",,,36,,,24.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.18,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",32.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.75,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",30.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.82,34.2,
".Urine Volume",2281050,CDM,300,RC,81050,HCPCS,"OUTPATIENT ",,,7.68,,,5.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.77,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.12,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6.91,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.75,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.77,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",2.15,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",6.53,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4.61,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.15,15.75,
"10006 US Fine Needle Aspiration/Biopsy Ea Addl",BO10006,CDM,402,RC,10006,HCPCS,"OUTPATIENT ",,,257,,,172.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",68.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",231.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",68.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",71.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",244.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",218.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",154.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",70.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",68.8,244.15,
"10021 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE TechFee",210021,CDM,450,RC,10021,HCPCS,"OUTPATIENT ",,,1941,,,1300.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",543.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",519.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",543.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1746.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",548.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",519.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",543.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1843.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1649.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",543.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1164.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",530.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",519.61,1843.95,
"10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee",210060,CDM,450,RC,10060,HCPCS,"OUTPATIENT ",,,171.9,,,115.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",48.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",48.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",154.71,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",46.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",48.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",163.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",146.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",48.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",103.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",46.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.02,163.31,
"10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee",210061,CDM,450,RC,10061,HCPCS,"OUTPATIENT ",,,2908,,,1948.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",814.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",778.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",814.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2617.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",822.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",778.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",814.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2762.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2471.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",814.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1744.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",794.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",778.47,2762.6,
"10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE TechFee",210080,CDM,450,RC,10080,HCPCS,"OUTPATIENT ",,,1907,,,1277.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",533.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",510.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",533.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1716.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",539.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",510.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",533.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1811.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1620.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",533.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1144.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",520.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",510.5,1811.65,
"10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee",210120,CDM,450,RC,10120,HCPCS,"OUTPATIENT ",,,3042,,,2038.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",851.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",851.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2737.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",851.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2889.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2585.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",851.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",830.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.34,2889.9,
"10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL TechFee",210121,CDM,450,RC,10121,HCPCS,"OUTPATIENT ",,,8416,,,5638.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2356.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2252.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2356.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7574.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2380.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2252.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2356.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7995.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7153.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2356.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5049.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2298.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2252.96,7995.2,
"10140 I&D HEMATOMA SEROMA/FLUID COLLECTION TechFee",210140,CDM,450,RC,10140,HCPCS,"OUTPATIENT ",,,4530,,,3035.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1268.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1212.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1268.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4077,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1281.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1212.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1268.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4303.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3850.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1268.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2718,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1237.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1212.68,4303.5,
"10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST TechFee",210160,CDM,450,RC,10160,HCPCS,"OUTPATIENT ",,,1880,,,1259.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",526.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",503.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",526.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1692,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",531.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",503.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",526.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1786,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1598,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",526.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1128,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",513.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",503.28,1786,
"11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee",211000,CDM,450,RC,11000,HCPCS,"OUTPATIENT ",,,1605,,,1075.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",429.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1444.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",453.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",429.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",449.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1524.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1364.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",963,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",438.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",429.66,1524.75,
"11001 DEBRID EA ADD 10% BOD SUR TechFee",211001,CDM,450,RC,11001,HCPCS,"OUTPATIENT ",,,42,,,28.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",37.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",11.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",39.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",35.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.24,39.9,
"11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS TechFee",211010,CDM,450,RC,11010,HCPCS,"OUTPATIENT ",,,1907,,,1277.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",533.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",510.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",533.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1716.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",539.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",510.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",533.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1811.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1620.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",533.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1144.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",520.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",510.5,1811.65,
"11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee",211042,CDM,450,RC,11042,HCPCS,"OUTPATIENT ",,,1844,,,1235.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",516.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",493.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",516.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1659.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",521.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",493.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",516.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1751.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1567.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",516.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1106.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",503.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",493.64,1751.8,
"11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 TechFee",211200,CDM,450,RC,11200,HCPCS,"OUTPATIENT ",,,158,,,105.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",142.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",150.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",134.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",94.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.3,150.1,
"11441 EX BEN LES FACE TechFee",211441,CDM,450,RC,11441,HCPCS,"OUTPATIENT ",,,342,,,229.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",95.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",91.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",95.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",307.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",96.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",91.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",95.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",324.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",290.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",95.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",205.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",93.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",91.55,324.9,
"11719 TRIM NONDYSTROPHIC NAILS ANY # TechFee",211719,CDM,450,RC,11719,HCPCS,"OUTPATIENT ",,,34,,,22.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",30.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",32.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",28.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9.1,32.3,
"11720 DEBRIDEMENT NAIL ANY METHOD 1-5 TechFee",211720,CDM,450,RC,11720,HCPCS,"OUTPATIENT ",,,94,,,62.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",84.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",89.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",79.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",56.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.16,89.3,
"11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee",211730,CDM,450,RC,11730,HCPCS,"OUTPATIENT ",,,271,,,181.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",243.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",75.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",257.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",230.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",162.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",74.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",72.55,257.45,
"11732 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH AD TechFee",211732,CDM,450,RC,11732,HCPCS,"OUTPATIENT ",,,80,,,53.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",22.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",21.42,76,
"11740 EVACUATION SUBUNGUAL HEMATOMA TechFee",211740,CDM,450,RC,11740,HCPCS,"OUTPATIENT ",,,103,,,69.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",92.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",97.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",87.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",61.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.57,97.85,
"11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee",211750,CDM,450,RC,11750,HCPCS,"OUTPATIENT ",,,449,,,300.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",120.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",404.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",120.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",426.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",381.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",269.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",120.2,426.55,
"11760 REPAIR NAIL BED TechFee",211760,CDM,450,RC,11760,HCPCS,"OUTPATIENT ",,,752,,,503.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",210.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",201.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",210.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",676.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",212.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",201.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",210.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",714.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",639.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",210.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",451.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",205.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",201.31,714.4,
"11765 WEDGE EXCISION SKIN NAIL FOLD TechFee",211765,CDM,450,RC,11765,HCPCS,"OUTPATIENT ",,,250,,,167.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.93,237.5,
"12+Oxycodone+Crt-Unbund LC",2280307,CDM,301,RC,80307,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.9,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.65,53.65,53.65,"1 through 10",other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.9,179.32,
"12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee",212001,CDM,450,RC,12001,HCPCS,"OUTPATIENT ",,,327.6,,,219.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",91.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",87.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",91.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",294.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",92.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",87.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",91.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",311.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",278.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",91.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",196.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",89.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",87.7,311.22,
"12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee",212002,CDM,450,RC,12002,HCPCS,"OUTPATIENT ",,,351.45,,,235.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",98.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",94.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",98.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",316.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,417.08,329.74,504.42,"1 through 10",other,"not separately reimbursment",99.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",94.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",98.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",333.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",298.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",98.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",210.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",95.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",94.08,333.88,
"12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee",212004,CDM,450,RC,12004,HCPCS,"OUTPATIENT ",,,816.3,,,546.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",228.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",218.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",228.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",734.67,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",230.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",218.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",228.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",775.49,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",693.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",228.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",489.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",222.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",218.52,775.49,
"12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee",212005,CDM,450,RC,12005,HCPCS,"OUTPATIENT ",,,1208,,,809.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",338.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",323.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",338.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1087.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",341.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",323.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",338.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1147.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1026.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",338.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",724.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",329.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",323.38,1147.6,
"12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM TechFee",212006,CDM,450,RC,12006,HCPCS,"OUTPATIENT ",,,981,,,657.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",882.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",931.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",833.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",588.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.61,931.95,
"12007 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM TechFee",212007,CDM,450,RC,12007,HCPCS,"OUTPATIENT ",,,550,,,368.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",147.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",495,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",155.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",147.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",522.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",467.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154,28,,,,,0,"percent of total billed charges ","28% of total billed charges",330,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",150.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",147.24,522.5,
"12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee",212011,CDM,450,RC,12011,HCPCS,"OUTPATIENT ",,,324.45,,,217.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",86.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",292.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",86.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",90.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",308.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",275.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",194.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",88.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",86.86,308.23,
"12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee",212013,CDM,450,RC,12013,HCPCS,"OUTPATIENT ",,,354.6,,,237.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",99.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",94.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",99.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",319.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,530.67,530.67,530.67,"1 through 10",other,"not separately reimbursment",100.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",94.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",99.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",336.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",301.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",99.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",212.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",96.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",94.93,336.87,
"12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee",212014,CDM,450,RC,12014,HCPCS,"OUTPATIENT ",,,873,,,584.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",244.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",233.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",244.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",785.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",246.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",233.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",244.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",829.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",742.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",244.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",523.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",238.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",233.7,829.35,
"12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM TechFee",212015,CDM,450,RC,12015,HCPCS,"OUTPATIENT ",,,912,,,611.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",255.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",244.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",255.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",820.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",257.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",244.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",255.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",866.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",775.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",255.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",547.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",249.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",244.14,866.4,
"12016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM TechFee",212016,CDM,450,RC,12016,HCPCS,"OUTPATIENT ",,,784,,,525.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",209.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",705.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",221.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",209.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",219.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",744.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",470.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",214.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",209.88,744.8,
"12017 SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM TechFee",212017,CDM,450,RC,12017,HCPCS,"OUTPATIENT ",,,1059,,,709.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",953.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",299.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",296.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1006.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",900.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",635.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.49,1006.05,
"12018 SIMPLE REPAIR F/E/E/N/L/M >30.0 CM TechFee",212018,CDM,450,RC,12018,HCPCS,"OUTPATIENT ",,,550,,,368.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",147.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",495,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",155.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",147.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",522.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",467.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154,28,,,,,0,"percent of total billed charges ","28% of total billed charges",330,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",150.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",147.24,522.5,
"12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE TechFee",212020,CDM,450,RC,12020,HCPCS,"OUTPATIENT ",,,1153,,,772.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",322.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",308.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",322.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1037.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,387.62,387.62,387.62,"1 through 10",other,"not separately reimbursment",326.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",308.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",322.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1095.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",980.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",322.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",691.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",314.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",308.66,1095.35,
"12021 TX SUPERFICIAL WOUND DEHISCENCE W/PACKING TechFee",212021,CDM,450,RC,12021,HCPCS,"OUTPATIENT ",,,355,,,237.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",99.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",95.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",99.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",319.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",95.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",99.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",337.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",301.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",99.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",213,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",96.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",95.03,337.25,
"12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee",212031,CDM,450,RC,12031,HCPCS,"OUTPATIENT ",,,2085,,,1396.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",583.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",558.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",583.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1876.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",589.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",558.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",583.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1980.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1772.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",583.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1251,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",569.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",558.15,1980.75,
"12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM TechFee",212032,CDM,450,RC,12032,HCPCS,"OUTPATIENT ",,,2275,,,1524.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",637,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",609.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",637,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2047.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,539.56,539.56,539.56,"1 through 10",other,"not separately reimbursment",643.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",609.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",637,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2161.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1933.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",637,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1365,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",621.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",609.02,2161.25,
"12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM TechFee",212034,CDM,450,RC,12034,HCPCS,"OUTPATIENT ",,,2592,,,1736.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",725.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",693.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",725.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2332.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",733.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",693.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",725.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2462.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2203.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",725.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1555.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",707.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",693.88,2462.4,
"12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM TechFee",212035,CDM,450,RC,12035,HCPCS,"OUTPATIENT ",,,1632,,,1093.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",456.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",436.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",456.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1468.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",461.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",436.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",456.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1550.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1387.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",456.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",979.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",445.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",436.89,1550.4,
"12036 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM TechFee",212036,CDM,450,RC,12036,HCPCS,"OUTPATIENT ",,,3296,,,2208.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",922.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",882.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",922.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2966.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",932.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",882.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",922.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3131.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2801.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",922.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1977.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",900.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",882.34,3131.2,
"12037 REPAIR INTERMEDIATE S/A/T/E >30.0 CM TechFee",212037,CDM,450,RC,12037,HCPCS,"OUTPATIENT ",,,5248,,,3516.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1404.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4723.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1484.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1404.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1469.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4985.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4460.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3148.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1433.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1404.89,4985.6,
"12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee",212041,CDM,450,RC,12041,HCPCS,"OUTPATIENT ",,,1941,,,1300.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",543.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",519.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",543.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1746.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",548.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",519.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",543.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1843.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1649.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",543.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1164.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",530.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",519.61,1843.95,
"12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee",212042,CDM,450,RC,12042,HCPCS,"OUTPATIENT ",,,2244,,,1503.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",628.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",600.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",628.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2019.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",634.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",600.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",628.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2131.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1907.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",628.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1346.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",612.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",600.72,2131.8,
"12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM TechFee",212044,CDM,450,RC,12044,HCPCS,"OUTPATIENT ",,,2738,,,1834.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",766.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",732.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",766.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2464.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",774.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",732.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",766.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2601.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2327.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",766.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1642.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",747.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",732.96,2601.1,
"12045 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM TechFee",212045,CDM,450,RC,12045,HCPCS,"OUTPATIENT ",,,1605,,,1075.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",429.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1444.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",453.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",429.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",449.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1524.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1364.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",963,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",438.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",429.66,1524.75,
"12046 RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM TechFee",212046,CDM,450,RC,12046,HCPCS,"OUTPATIENT ",,,1605,,,1075.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",429.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1444.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",453.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",429.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",449.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1524.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1364.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",449.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",963,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",438.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",429.66,1524.75,
"12047 REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM TechFee",212047,CDM,450,RC,12047,HCPCS,"OUTPATIENT ",,,5248,,,3516.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1404.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4723.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1484.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1404.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1469.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4985.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4460.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3148.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1433.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1404.89,4985.6,
"12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< TechFee",212051,CDM,450,RC,12051,HCPCS,"OUTPATIENT ",,,3775,,,2529.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1057,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1010.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1057,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3397.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1067.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1010.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1057,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3586.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3208.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1057,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2265,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1030.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1010.57,3586.25,
"12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM TechFee",212052,CDM,450,RC,12052,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1075.87,3817.98,
"12053 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM TechFee",212053,CDM,450,RC,12053,HCPCS,"OUTPATIENT ",,,1809,,,1212.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",506.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",484.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",506.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1628.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",511.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",484.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",506.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1718.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1537.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",506.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1085.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",494.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",484.27,1718.55,
"12054 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM TechFee",212054,CDM,450,RC,12054,HCPCS,"OUTPATIENT ",,,1597,,,1069.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",447.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",427.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",447.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1437.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",451.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",427.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",447.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1517.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1357.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",447.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",958.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",436.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",427.52,1517.15,
"12055 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM TechFee",212055,CDM,450,RC,12055,HCPCS,"OUTPATIENT ",,,1059,,,709.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",953.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",299.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",296.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1006.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",900.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",635.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.49,1006.05,
"12056 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM TechFee",212056,CDM,450,RC,12056,HCPCS,"OUTPATIENT ",,,1059,,,709.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",953.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",299.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",296.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1006.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",900.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",635.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.49,1006.05,
"12057 REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM TechFee",212057,CDM,450,RC,12057,HCPCS,"OUTPATIENT ",,,1059,,,709.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",953.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",299.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",296.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1006.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",900.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",296.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",635.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.49,1006.05,
"13100 REPAIR COMPLEX TRUNK 1.1-2.5 CM TechFee",213100,CDM,450,RC,13100,HCPCS,"OUTPATIENT ",,,968,,,648.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",271.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",259.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",271.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",871.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",273.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",259.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",271.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",919.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",822.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",271.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",580.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",264.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",259.13,919.6,
"13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM TechFee",213101,CDM,450,RC,13101,HCPCS,"OUTPATIENT ",,,1155,,,773.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",323.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",309.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",323.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1039.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",326.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",309.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",323.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1097.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",981.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",323.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",693,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",315.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",309.19,1097.25,
"13102 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< TechFee",213102,CDM,450,RC,13102,HCPCS,"OUTPATIENT ",,,354,,,237.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",99.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",94.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",99.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",318.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",94.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",99.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",336.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",300.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",99.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",212.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",96.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",94.77,336.3,
"13120 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM TechFee",213120,CDM,450,RC,13120,HCPCS,"OUTPATIENT ",,,1013,,,678.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",283.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",271.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",283.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",911.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",286.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",271.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",283.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",962.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",861.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",283.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",607.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",276.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",271.18,962.35,
"13121 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM TechFee",213121,CDM,450,RC,13121,HCPCS,"OUTPATIENT ",,,1051,,,704.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",294.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",281.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",294.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",945.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",297.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",281.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",294.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",998.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",893.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",294.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",630.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",287.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",281.35,998.45,
"13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< TechFee",213122,CDM,450,RC,13122,HCPCS,"OUTPATIENT ",,,300,,,201,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",270,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",285,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",255,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.31,285,
"13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM TechFee",213131,CDM,450,RC,13131,HCPCS,"OUTPATIENT ",,,1117,,,748.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",312.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",299.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",312.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1005.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",315.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",299.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",312.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1061.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",949.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",312.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",670.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",305.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",299.02,1061.15,
"13132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM TechFee",213132,CDM,450,RC,13132,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"13133 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< TechFee",213133,CDM,450,RC,13133,HCPCS,"OUTPATIENT ",,,426,,,285.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",114.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",383.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",114.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",404.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",362.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",114.04,404.7,
"13151 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM TechFee",213151,CDM,450,RC,13151,HCPCS,"OUTPATIENT ",,,824,,,552.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",230.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",220.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",230.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",741.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",233.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",220.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",230.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",782.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",700.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",230.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",494.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",225.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",220.58,782.8,
"13152 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM TechFee",213152,CDM,450,RC,13152,HCPCS,"OUTPATIENT ",,,1133,,,759.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",317.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",303.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",317.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1019.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",320.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",303.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",317.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1076.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",963.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",317.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",679.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",309.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",303.3,1076.35,
"13153 REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/ TechFee",213153,CDM,450,RC,13153,HCPCS,"OUTPATIENT ",,,542,,,363.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",151.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",145.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",151.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",487.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",145.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",151.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",514.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",460.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",151.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",325.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",148.02,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",145.09,514.9,
"14.3.3 ETA, Rheum. Arthritis LC",2286431,CDM,302,RC,86431,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.9,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,109.19,49.93,168.45,"1 through 10",other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.14,177.65,
"14000 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10CM OR LESS",614000,CDM,360,RC,14000,HCPCS,"OUTPATIENT ",,,2714,,,1818.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",759.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",726.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",759.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2442.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",767.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",726.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",759.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2578.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2306.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",759.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1628.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",741.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",726.54,2578.3,
"14X10 BIOPSY GUN",1400360,CDM,272,RC,A4590,HCPCS,"OUTPATIENT ",,,839.25,,,562.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",755.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",237.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",224.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",234.99,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",797.29,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",713.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges",503.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",224.67,797.29,
"15.5FR X 28CM TITAN",682700,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,495,,,331.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",138.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",132.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",138.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",495,100,,,,,0,"fee schedule","100% of total billed charges",445.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",139.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",132.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",138.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",470.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",420.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",138.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",297,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",135.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",132.51,495,
"150mm, 13G INSUFFLATIO NEEDLE",690791,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,39,,,26.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",35.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",37.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",33.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",23.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.44,37.05,
"15853. Removal of sutures or staples not requiring anesthesia",215853,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,27,,,18.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",24.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.23,25.65,
"16000 INITIAL TX 1ST DEGREE BURN LOCAL TX TechFee",216000,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,142,,,95.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",127.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",39.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",134.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",120.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",38.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.01,134.9,
"16020 Dressings and/or debridement of partial-thickness burns, initial or subsequent, small",616020,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,133,,,89.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",119.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",113.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.6,126.35,
"16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL TechFee",216020,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,133,,,89.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",119.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",113.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.6,126.35,
"16025 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM TechFee",216025,CDM,450,RC,A9552,HCPCS,"OUTPATIENT ",,,266,,,178.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",239.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",226.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",71.21,252.7,
"16030 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE TechFee",216030,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,518,,,347.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",145.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",145.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",466.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",146.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",145.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",492.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",440.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",145.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",310.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",141.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.67,492.1,
"17250 CHEMICAL CAUTERIZATION GRANULATION TISSUE tech",217250,CDM,450,RC,C1762,HCPCS,"OUTPATIENT ",,,145,,,97.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",130.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",137.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",123.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.82,137.75,
"17-OH Progesterone LCMS LC",2284398,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,359,,,240.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",100.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",96.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",100.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",323.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",101.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",96.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",100.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",341.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",305.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",100.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",215.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",98.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",96.1,341.05,
"18G X 1 1/2 NEEDLE",680034,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,0.68,,,0.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",0.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",63.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.19,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",0.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",0.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges",0.41,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.18,63.61,
"2 BLUE CAST TAPE",690528,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,8.64,,,5.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.31,8.21,
"2 CAST PADDING SYNTHETIC",690526,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,1.74,,,1.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.47,1.65,
"2 LMA PLUS PACK",680091,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,15,,,10.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.02,14.25,
"2 PINK CAST TAPE",690529,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,8.64,,,5.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.31,8.21,
"2 PURPLE CAST TAPE",690324,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,8.61,,,5.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.17,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.3,8.18,
"2 WHITE CAST TAPE",690527,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,8.4,,,5.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.35,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.25,7.98,
"2.4MM SLIT KNIFE",680073,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,67.71,,,45.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",60.94,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",18.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",64.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",57.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",40.63,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.13,64.32,
"2.5 DRIVER TIP",690306,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,345,,,231.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",92.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",310.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",92.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",96.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",327.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",293.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",207,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",94.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",92.36,327.75,
"2.5 LMA PLUS PACK",680092,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,15,,,10.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.02,14.25,
"2-0 STRATAFIX SPIRAL PDS  CT-2",664450,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,91.05,,,61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",77.39,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.63,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.37,86.5,
"2-0 STRATAFIX SPIRAL PDS SH 15CM",664445,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,92.34,,,61.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",83.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",87.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",78.49,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",55.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.72,87.72,
"2-0 VICRYL",680225,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,24.78,,,16.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",22.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",21.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.63,23.54,
"20102 EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK TechFee",220102,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1372,,,919.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",384.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",367.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",384.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1234.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",367.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",384.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1303.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1166.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",384.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",823.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",374.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",367.28,1303.4,
"20103 EXPLORATION PENETRATING WOUND SPX EXTREMITY TechFee",220103,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1438,,,963.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",402.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",384.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",402.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1294.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",406.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",384.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",402.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1366.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1222.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",402.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",862.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",392.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",384.95,1366.1,
"2019 Novel Coronavirus (CoVID-19), NAA LC",2280002,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,60.5,,,40.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",54.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",16.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",51.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16.2,57.48,
"20520 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE TechFee",220520,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,386,,,258.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",108.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",103.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",108.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",347.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",109.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",103.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",108.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",366.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",328.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",108.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",231.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",105.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",103.33,366.7,
"20560 Dry Needling 1-2 Muscles",4620560,CDM,761,RC,C1776,HCPCS,"OUTPATIENT ",,,75,,,50.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",67.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",71.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",63.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.08,71.25,
"20561 Dry Needling 3+ Muscles",4620561,CDM,420,RC,C1713,HCPCS,"OUTPATIENT ",,,70,,,46.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.74,66.5,
"20600-Small Joint Aspirate/Inject w/o US TechFee",220600,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,148,,,99.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",133.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",41.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",140.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",125.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.62,140.6,
"20610-L Drain/inj joint/bursa w/o us",220610,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,250,,,167.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.93,237.5,
"20610-R Drain/inj joint/bursa w/o us",220610,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,250,,,167.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.93,237.5,
"20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US",220611,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,318,,,213.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",89.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",89.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",286.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",85.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",89.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",302.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",270.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",89.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",190.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",86.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",85.13,302.1,
"20612 ASPIRATION CYST-ER SERV PROCEDURE",220612,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,176,,,117.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",158.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",167.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",149.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",105.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.12,167.2,
"20690 Application of a uniplane (pins or wires in 1 plane) unilateral, external fixation system",620690,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,2566,,,1719.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",718.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",686.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",718.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2309.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",725.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",686.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",718.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2437.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2181.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",718.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1539.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",700.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",686.92,2437.7,
"20822 RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP TechFee",220822,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1031,,,690.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",288.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",276,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",288.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",927.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",291.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",276,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",288.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",979.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",876.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",288.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",618.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",281.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",276,979.45,
"20G TUOHY EPIDURAL NEEDLE 3.5 INCH",690391,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,26.16,,,17.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",23.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7,24.85,
"20G X 1.75 INTROCAN",200022,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,9.54,,,6.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",8.59,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8.11,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.55,9.06,
"2108 Series Sagittal Blade 20.7 x 0.88 x 85.0mm",691518,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,65.13,,,43.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",58.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",18.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",61.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",55.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",39.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",17.44,61.87,
"2108 Series Sagittal Blade, Ground (12.5 x 1.27 x 73.0mm)",691498,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,73.98,,,49.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",66.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.71,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",70.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",62.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges",44.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.8,70.28,
"2108 Series Sagittal Blade, Ground 25.0 x 1.27 x 91.5 mm",691291,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,65.13,,,43.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",58.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",18.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",61.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",55.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",39.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",17.44,61.87,
"21315 CLOSED TX NASAL FRACTURE W/O STABILIZATION TechFee",221315,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,580,,,388.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",162.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",155.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",162.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",522,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",164.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",155.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",162.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",551,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",493,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",162.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",348,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",158.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",155.27,551,
"21320 CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION TechFee",221320,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,752,,,503.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",210.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",201.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",210.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",676.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",212.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",201.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",210.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",714.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",639.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",210.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",451.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",205.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",201.31,714.4,
"21480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ TechFee",221480,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,311,,,208.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",87.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",83.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",87.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",279.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",87.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",83.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",87.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",295.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",264.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",87.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",186.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",84.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",83.25,295.45,
"23500 CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION TechFee",223500,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,632,,,423.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",169.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",568.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",169.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",176.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",600.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",537.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",379.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",169.19,600.4,
"23575 CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION TechFee",223575,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2029,,,1359.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",568.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",543.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",568.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1826.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",573.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",543.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",568.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1927.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1724.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",568.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1217.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",554.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",543.16,1927.55,
"23600 TREAT HUMERUS FRACTURE TechFee",223600,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,632,,,423.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",169.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",568.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",169.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",176.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",600.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",537.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",379.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",169.19,600.4,
"23605 CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ TechFee",223605,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1368,,,916.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",383.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",366.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",383.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1231.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",386.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",366.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",383.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1299.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1162.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",383.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",820.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",373.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",366.21,1299.6,
"23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES TechFee",223650,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2157,,,1445.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",603.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",577.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",603.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1941.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",610,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",577.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",603.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2049.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1833.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",603.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1294.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",589.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",577.43,2049.15,
"23655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES TechFee",223655,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,939,,,629.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",262.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",251.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",262.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",845.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",265.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",251.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",262.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",892.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",798.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",262.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",563.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",256.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",251.37,892.05,
"23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ TechFee",223665,CDM,450,RC,C1719,HCPCS,"OUTPATIENT ",,,1035,,,693.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",289.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",277.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",289.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",931.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",292.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",277.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",289.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",983.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",879.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",289.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",621,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",282.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",277.07,983.25,
"23675 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ TechFee",223675,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1561,,,1045.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",437.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",417.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",437.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1404.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",441.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",417.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",437.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1482.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1326.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",437.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",936.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",426.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",417.88,1482.95,
"23931 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; BURSA TechFee",223931,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,703,,,471.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",196.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",188.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",196.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",632.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",198.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",188.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",196.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",667.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",597.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",196.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",421.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",191.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",188.19,667.85,
"24 FRENCH NASAL AIRW",260031,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,13.8,,,9.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.69,13.11,
"24200 Fb Rem Upper Arm/Elbow-Sq TechFee",224200,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,928,,,621.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",259.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",259.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",835.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",262.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",259.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",881.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",788.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",259.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",556.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.43,881.6,
"24500 TREAT HUMERUS FRACTURE TechFee",224500,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,895,,,599.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",250.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",239.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",250.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",805.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",253.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",239.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",250.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",850.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",760.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",250.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",537,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",244.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",239.59,850.25,
"24505 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ TechFee",224505,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1323,,,886.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",370.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",354.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",370.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1190.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",374.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",354.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",370.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1256.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1124.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",370.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",793.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",361.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",354.17,1256.85,
"24535 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ TechFee",224535,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1694,,,1134.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",474.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",453.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",474.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1524.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",479.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",453.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",474.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1609.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1439.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",474.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1016.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",462.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",453.48,1609.3,
"24576 CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ TechFee",224576,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,632,,,423.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",169.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",568.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",169.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",176.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",600.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",537.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",379.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",169.19,600.4,
"24577 CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ TechFee",224577,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2569,,,1721.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",719.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",687.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",719.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2312.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",726.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",687.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",719.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2440.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2183.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",719.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1541.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",701.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",687.72,2440.55,
"24605 TREATMENT CLOSED ELBOW DISLOCATION REQ ANES TechFee",224605,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1657,,,1110.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",463.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",443.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",463.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1491.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",443.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",463.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1574.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1408.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",463.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",994.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",452.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",443.58,1574.15,
"24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ TechFee",224620,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1474,,,987.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",412.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",394.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",412.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1326.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",416.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",394.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",412.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1400.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1252.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",412.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",884.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",402.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",394.59,1400.3,
"24640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ TechFee",224640,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,541,,,362.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",151.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",144.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",151.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",486.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",152.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",144.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",151.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",513.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",459.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",151.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",324.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",147.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",144.83,513.95,
"24655 CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION TechFee",224655,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1127,,,755.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",315.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",301.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",315.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1014.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",318.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",301.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",315.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1070.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",957.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",315.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",676.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",307.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",301.7,1070.65,
"24675 CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ TechFee",224675,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1161,,,777.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",325.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",310.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",325.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1044.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",328.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",310.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",325.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1102.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",986.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",325.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",696.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",317.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",310.8,1102.95,
"24g Surgical Steel",691173,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1.2,,,0.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1.14,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",0.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.32,1.14,
"25028 INC/DRAIN DEEP ABCESS FOREARM TechFee",225028,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2957,,,1981.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",827.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",791.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",827.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2661.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",836.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",791.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",827.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2809.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2513.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",827.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1774.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",807.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",791.59,2809.15,
"25500 TREAT FRACTURE OF RADIUS TechFee",225500,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,659,,,441.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",184.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",176.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",184.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",593.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",186.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",176.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",184.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",626.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",560.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",184.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",395.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",179.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",176.41,626.05,
"25505 CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION TechFee",225505,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1270,,,850.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",355.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",339.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",355.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1143,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",359.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",339.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",355.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1206.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1079.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",355.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",762,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",346.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",339.98,1206.5,
"25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION TechFee",225535,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1261,,,844.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",353.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",337.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",353.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1134.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",356.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",337.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",353.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1197.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1071.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",353.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",756.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",344.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",337.57,1197.95,
"25560 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN TechFee",225560,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,713,,,477.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",641.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",201.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",199.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",677.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",606.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",427.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",194.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.87,677.35,
"25565 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ TechFee",225565,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2867,,,1920.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",802.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",767.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",802.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2580.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",810.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",767.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",802.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2723.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2436.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",802.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1720.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",782.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",767.5,2723.65,
"25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee",225600,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1278,,,856.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",357.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",342.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",357.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1150.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",361.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",342.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",357.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1214.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1086.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",357.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",766.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",349.02,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",342.12,1214.1,
"25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF TechFee",225605,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,3495,,,2341.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",978.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",935.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",978.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3145.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",988.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",935.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",978.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3320.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2970.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",978.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2097,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",954.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",935.61,3320.25,
"25624 CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ TechFee",225624,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1256,,,841.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",351.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",336.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",351.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1130.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",355.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",336.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",351.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1193.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1067.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",351.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",753.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",343.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",336.23,1193.2,
"25675 CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ TechFee",225675,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1584,,,1061.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",443.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",424.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",443.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1425.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",447.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",424.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",443.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1504.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1346.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",443.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",950.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",432.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",424.04,1504.8,
"25690 CLOSED TX LUNATE DISLOCATION W/MANIPULATION TechFee",225690,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1424,,,954.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",398.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",381.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",398.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1281.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",381.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",398.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1352.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1210.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",398.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",854.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",388.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",381.2,1352.8,
"25G Irrigating Cystotome",691588,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,13.77,,,9.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.69,13.08,
"25G X 1 1/2 NEEDLE",680033,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,0.96,,,0.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",0.86,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",63.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.27,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",0.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",0.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges",0.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.26,63.61,
"26010 DRAINAGE FINGER ABSCESS SIMPLE TechFee",226010,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,531,,,355.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",148.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",142.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",148.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",477.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",150.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",142.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",148.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",504.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",451.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",148.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",318.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",145.02,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",142.15,504.45,
"26011 DRAINAGE FINGER ABSCESS COMPLICATED TechFee",226011,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1034,,,692.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",289.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",276.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",289.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",930.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",292.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",276.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",289.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",982.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",878.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",289.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",620.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",282.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",276.8,982.3,
"26605 CLTX METACARPAL FX W/MANIPULATION EACH BONE TechFee",226605,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,840,,,562.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",235.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",235.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",756,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",237.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",224.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",235.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",798,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",714,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",235.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",504,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",224.87,798,
"26641 CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ TechFee",226641,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,866,,,580.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",242.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",231.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",242.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",779.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",244.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",231.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",242.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",822.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",736.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",242.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",519.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",236.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",231.83,822.7,
"26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES TechFee",226670,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1221,,,818.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",341.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",326.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",341.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1098.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",345.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",326.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",341.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1159.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1037.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",341.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",732.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",333.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",326.86,1159.95,
"26700 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES TechFee",226700,CDM,450,RC,S8185,HCPCS,"OUTPATIENT ",,,698,,,467.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",195.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",195.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",628.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",197.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",195.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",663.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",593.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",195.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",418.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.85,663.1,
"26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA TechFee",226720,CDM,450,RC,G0481,HCPCS,"OUTPATIENT ",,,853,,,571.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",238.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",238.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",767.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",63.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,94.97,58.78,205.27,"1 through 10",other,"not separately reimbursment",241.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",238.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",810.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",131.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",725.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",238.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",511.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",63.61,810.35,
"26725 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA TechFee",226725,CDM,450,RC,C9359,HCPCS,"OUTPATIENT ",,,845,,,566.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",236.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",226.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",236.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",760.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",226.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",236.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",802.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",718.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",236.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",507,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",230.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",226.21,802.75,
"26742 CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT",226742,CDM,450,RC,C1762,HCPCS,"OUTPATIENT ",,,1067,,,714.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",298.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",285.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",298.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",960.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",301.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",285.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",298.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1013.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",906.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",298.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",640.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",291.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",285.64,1013.65,
"26755 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA TechFee",226755,CDM,450,RC,Q4199,HCPCS,"OUTPATIENT ",,,738,,,494.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",206.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",197.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",206.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",664.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",208.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",197.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",206.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",701.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",627.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",206.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",442.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",201.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",197.56,701.1,
"26765 OPEN TX DISTAL PHALANGEAL FRACTURE EACH TechFee",226765,CDM,450,RC,Q4139,HCPCS,"OUTPATIENT ",,,1405,,,941.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",393.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",376.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",393.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1264.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",397.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",376.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",393.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1334.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1194.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",393.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",843,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",383.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",376.12,1334.75,
"26770 CLTX IPHAL JT DISLC W/MANJ",226770,CDM,450,RC,C9359,HCPCS,"OUTPATIENT ",,,1844,,,1235.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",516.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",493.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",516.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1659.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",521.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",493.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",516.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1751.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1567.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",516.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1106.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",503.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",493.64,1751.8,
"26775 CLTX IPHAL JT DISLC W/MANJ REQ ANES TechFee",226775,CDM,450,RC,Q4100,HCPCS,"OUTPATIENT ",,,868,,,581.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",243.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",232.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",243.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",781.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",245.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",232.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",243.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",824.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",737.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",243.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",520.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",237.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",232.36,824.6,
"26951 AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR TechFee",226951,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1946,,,1303.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",544.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",520.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",544.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1751.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",550.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",520.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",544.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1848.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1654.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",544.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1167.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",531.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",520.94,1848.7,
"27040 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; SUPERFICIAL ProFee",1827040,CDM,359,RC,C1713,HCPCS,"OUTPATIENT ",,,576,,,385.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",154.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",518.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",162.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",154.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",161.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",547.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",489.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",345.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",157.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",154.2,547.2,
"27041 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; DEEP, SUBFASCIAL OR INTRAMUSCULAR ProFee",1827041,CDM,359,RC,C1713,HCPCS,"OUTPATIENT ",,,1786,,,1196.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",500.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",478.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",500.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1607.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",505.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",478.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",500.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1696.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1518.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",500.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1071.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",487.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",478.11,1696.7,
"27200 CLOSED TREATMENT OF COCCYGEAL FRACTURE TechFee",227200,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,632,,,423.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",169.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",568.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",169.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",176.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",600.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",537.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",379.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",169.19,600.4,
"27246 CLTX GREATER TROCHANTERIC FX W/O MANJ TechFee",227246,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,632,,,423.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",169.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",568.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",169.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",176.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",600.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",537.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",176.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",379.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",169.19,600.4,
"27250 CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA TechFee",227250,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,993,,,665.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",278.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",265.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",278.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",893.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",280.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",265.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",278.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",943.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",844.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",278.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",595.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",271.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",265.83,943.35,
"27265 CLTX POST HIP ARTHRP DISLC W/O ANES TechFee",227265,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1188,,,795.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",332.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",318.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",332.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1069.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",335.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",318.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",332.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1128.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1009.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",332.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",712.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",324.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",318.03,1128.6,
"27301 I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION TechFee",227301,CDM,450,RC,C9359,HCPCS,"OUTPATIENT ",,,1692,,,1133.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",473.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",452.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",473.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1522.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",478.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",452.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",473.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1607.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1438.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",473.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1015.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",462.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",452.95,1607.4,
"27502 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ TechFee",227502,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2560,,,1715.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",716.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",685.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",716.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2304,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",723.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",685.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",716.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2432,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2176,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",716.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1536,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",699.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",685.31,2432,
"27510 ED TREATMENT OF THIGH FRACTURE TechFee",227510,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2296,,,1538.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",642.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",614.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",642.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2066.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",649.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",614.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",642.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2181.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1951.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",642.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1377.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",627.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",614.64,2181.2,
"27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA TechFee",227550,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2024,,,1356.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",541.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1821.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",572.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",541.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",566.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1922.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1720.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1214.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",552.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",541.82,1922.8,
"27552 TREATMENT CL KNEE DISLOCATIO-ER SERV PRO",227552,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1965,,,1316.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",550.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",550.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1768.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",555.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",550.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1866.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1670.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",550.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1179,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",536.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.03,1866.75,
"27560 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA TechFee",227560,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1578,,,1057.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",441.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",422.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",441.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1420.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",446.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",422.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",441.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1499.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1341.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",441.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",946.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",430.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",422.43,1499.1,
"27752 CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ TechFee",227752,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1620,,,1085.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",433.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1458,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",458.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",433.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",453.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1539,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1377,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",972,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",442.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",433.67,1539,
"27762 CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ TechFee",227762,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1161,,,777.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",325.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",310.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",325.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1044.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",328.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",310.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",325.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1102.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",986.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",325.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",696.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",317.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",310.8,1102.95,
"27768 CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION. TechFee",227768,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1309,,,877.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",366.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",350.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",366.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1178.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",370.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",350.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",366.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1243.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1112.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",366.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",785.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",357.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",350.42,1243.55,
"27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee",227786,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,796,,,533.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",213.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",716.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",225.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",213.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",222.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",756.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",676.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",477.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",217.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",213.09,756.2,
"27788 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ TechFee",227788,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1141,,,764.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",319.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",305.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",319.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1026.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",322.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",305.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",319.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1083.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",969.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",319.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",684.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",311.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",305.45,1083.95,
"27808 CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL TechFee",227808,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,867,,,580.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",242.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",232.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",242.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",780.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",245.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",232.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",242.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",823.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",736.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",242.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",520.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",236.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",232.1,823.65,
"27810 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ TechFee",227810,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1340,,,897.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",375.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",358.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",375.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1206,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",378.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",358.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",375.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1273,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1139,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",375.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",804,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",365.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",358.72,1273,
"27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION TechFee",227818,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1387,,,929.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",388.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",371.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",388.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1248.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",392.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",371.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",388.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1317.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1178.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",388.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",832.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",378.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",371.3,1317.65,
"27825 CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ TechFee",227825,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1716,,,1149.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",480.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",459.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",480.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1544.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",485.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",459.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",480.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1630.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1458.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",480.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1029.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",468.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",459.37,1630.2,
"27840 CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA TechFee",227840,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1687,,,1130.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",472.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",451.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",472.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1518.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",477.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",451.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",472.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1602.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1433.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",472.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1012.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",460.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",451.61,1602.65,
"27842 CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ TechFee",227842,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1372,,,919.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",384.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",367.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",384.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1234.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",367.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",384.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1303.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1166.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",384.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",823.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",374.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",367.28,1303.4,
"27G HYDRODISSECTION CANNULA",690264,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,12.69,,,8.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.55,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.61,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.4,12.06,
"27G Hydrodissection Cannula 11mm",691589,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,17.49,,,11.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",15.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",16.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10.49,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.68,16.62,
"28190 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS TechFee",228190,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,446,,,298.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",124.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",124.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",401.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",124.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",423.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",124.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",267.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",121.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.39,423.7,
"28192 REMOVAL FOREIGN BODY FOOT DEEP TechFee",228192,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,6663,,,4464.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1865.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1783.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1865.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5996.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1884.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1783.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1865.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6329.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5663.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1865.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3997.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1819.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1783.69,6329.85,
"28435 CLOSED TX TALUS FRACTURE W/MANIPULATION TechFee",228435,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1107,,,741.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",309.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",296.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",309.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",996.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",313.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",296.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",309.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1051.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",940.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",309.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",664.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",302.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",296.34,1051.65,
"28495 CLTX FX GRT TOE PHLX/PHLG W/MANJ TechFee",228495,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,405,,,271.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",108.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",364.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",108.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",113.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",384.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",344.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",243,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",108.42,384.75,
"28510 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ TechFee",228510,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,290,,,194.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",81.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",77.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",81.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",261,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",82.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",77.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",81.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",275.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",246.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",81.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",174,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",79.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",77.63,275.5,
"28515 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ TechFee",228515,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,360,,,241.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",100.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",96.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",100.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",324,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",101.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",96.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",100.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",342,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",306,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",100.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",216,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",98.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",96.37,342,
"28630 CLTX METATARSOPHLNGL JT DISLC W/O ANES TechFee",228630,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,367,,,245.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",98.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",330.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",103.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",98.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",102.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",348.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",311.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",220.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",100.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",98.25,348.65,
"28660 CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES TechFee",228660,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,314,,,210.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",87.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",84.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",87.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",282.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",88.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",84.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",87.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",298.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",266.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",87.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",188.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",85.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",84.06,298.3,
"29065 APPLICATION CAST SHOULDER HAND LONG ARM TechFee",229065,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,280,,,187.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",78.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",74.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",78.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",252,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",79.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",74.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",78.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",266,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",238,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",78.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",168,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",76.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",74.96,266,
"29075 APPLICATION CAST ELBOW FINGER SHORT ARM TechFee",229075,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,253,,,169.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",227.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",240.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",215.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",151.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",69.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.73,240.35,
"29085 CAST HAND/LOWER FOREARMT TechFee",229085,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,278,,,186.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",77.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",74.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",77.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",250.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",74.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",77.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",264.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",236.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",77.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",166.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",75.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",74.42,264.1,
"29105 APPLICATION  LONG ARM SPLINT (SHOULDER TO HAND)",229105,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,749,,,501.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",209.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",209.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",674.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",200.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",209.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",711.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",636.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",209.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",449.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",204.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.51,711.55,
"29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee",229125,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,757,,,507.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",211.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",202.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",211.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",681.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",214.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",202.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",211.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",719.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",643.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",211.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",454.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",206.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",202.65,719.15,
"29126 APPLICATION SHORT ARM SPLINT DYNAMIC TechFee",229126,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,986,,,660.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",276.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",263.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",276.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",887.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",278.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",263.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",276.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",936.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",838.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",276.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",591.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",269.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",263.95,936.7,
"29130 APPLICATION FINGER SPLINT STATIC",229130,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,560,,,375.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",156.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",149.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",156.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",504,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",158.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",149.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",156.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",532,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",476,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",156.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",336,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",152.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",149.91,532,
"29240 STRAPPING SHOULDER TechFee",229240,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,534,,,357.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",149.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",142.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",149.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",480.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",142.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",149.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",507.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",453.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",149.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",320.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",145.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",142.95,507.3,
"29260 STRAPPING ELBOW/WRIST TechFee",229260,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,343,,,229.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",96.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",91.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",96.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",308.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",91.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",96.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",325.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",291.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",96.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",205.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",93.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",91.82,325.85,
"29280 STRAPPING HAND/FINGER TechFee",229280,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,705,,,472.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",188.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",634.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",188.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",669.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",599.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",423,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",188.73,669.75,
"29345 APPLICATION LONG LEG CAST THIGH-TOE TechFee",229345,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,339,,,227.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.75,322.05,
"29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE TechFee",229405,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,398,,,266.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",111.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",111.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",358.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",112.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",111.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",378.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",338.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",111.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",238.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.54,378.1,
"29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee",229505,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,796,,,533.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",213.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",716.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",225.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",213.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",222.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",756.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",676.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",477.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",217.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",213.09,756.2,
"29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee",229515,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,810,,,542.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",216.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",729,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",216.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",226.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",769.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",688.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",486,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",221.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",216.84,769.5,
"29530 STRAPPING KNEE TechFee",229530,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,366,,,245.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",102.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",97.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",102.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",329.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",103.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",97.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",102.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",347.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",311.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",102.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",219.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",99.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",97.98,347.7,
"29540 STRAPPING ANKLE &/FOOT TechFee",229540,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,294,,,196.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",82.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",78.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",82.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",264.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",83.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",78.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",82.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",279.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",249.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",82.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",176.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",80.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",78.7,279.3,
"29550 STRAPPING TOES TechFee",229550,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,644,,,431.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",180.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",172.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",180.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",579.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",182.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",172.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",180.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",611.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",547.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",180.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",386.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",172.4,611.8,
"29580 STRAPPING UNNA BOOT TechFee",229580,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,113,,,75.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",101.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",107.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",67.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.25,107.35,
"29705 REMOVAL/BIVALVING FULL ARM/FULL LEG CAST TechFee",229705,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,164,,,109.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",147.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",45.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",155.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",139.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.9,155.8,
"29848 Endoscopy/Arthroscopy Procedures on the Musculoskeletal System",629848,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,1523,,,1020.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",426.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",407.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",426.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1370.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",430.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",407.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",426.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1446.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1294.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",426.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",913.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",415.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",407.71,1446.85,
"3 BLUE CAST TAPE",690534,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,10.41,,,6.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.79,9.89,
"3 GREEN CAST TAPE",690531,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,10.59,,,7.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.83,10.06,
"3 PINK CAST TAPE",680136,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,10.59,,,7.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.83,10.06,
"3 PURPLE CAST TAPE",690533,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,10.41,,,6.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.79,9.89,
"3 WHITE CAST TAPE",690530,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,10.29,,,6.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.17,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.75,9.78,
"3-0 PDS plus PS-2",690428,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,11.64,,,7.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",10.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.12,11.06,
"3-0 VICRYL",68278,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,27.96,,,18.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",25.16,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23.77,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.48,26.56,
"3-0 VICRYL CT",682730,CDM,272,RC,C9359,HCPCS,"OUTPATIENT ",,,3.93,,,2.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.05,3.73,
"30300 REMOVAL NASAL FOREIGN BODY-ER SERV PROCE",230300,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,504,,,337.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",134.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",453.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",134.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",141.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",478.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",428.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",302.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",137.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",134.92,478.8,
"30310 REMOVE NASAL FOREIGN BODY TechFee",230310,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,508,,,340.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",142.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",135.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",142.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",457.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",135.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",142.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",482.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",431.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",142.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",304.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",138.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",135.99,482.6,
"30901 CONTROL ANT. NASAL HEMORRHAGE- ER SERV P",230901,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1035,,,693.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",289.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",277.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",289.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",931.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",292.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",277.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",289.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",983.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",879.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",289.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",621,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",282.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",277.07,983.25,
"30903 CONTROL ANT. NASAL HEMOR,COMP- ER SERV P",230903,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.23,213.75,
"30905 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST TechFee",230905,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,513,,,343.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",143.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",137.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",143.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",461.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",137.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",143.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",487.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",436.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",143.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",307.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",137.33,487.35,
"30906 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ TechFee",230906,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,648,,,434.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",173.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",583.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",183.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",173.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",181.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",615.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",550.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",388.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",176.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",173.47,615.6,
"30CC LEUR LOCK SYRIN",680032,CDM,270,RC,G0465,HCPCS,"OUTPATIENT ",,,32.31,,,21.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",29.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9.05,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",27.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8.65,30.69,
"31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE TechFee",231500,CDM,360,RC,C9359,HCPCS,"OUTPATIENT ",,,773.25,,,518.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",216.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",216.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",695.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",218.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",207,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",216.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",734.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",657.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",216.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",463.95,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",211.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207,734.59,
"31502 INTRO PROC ON LARYNX TechFee",231502,CDM,450,RC,c1713,HCPCS,"OUTPATIENT ",,,168,,,112.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",151.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",47.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",159.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",142.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",100.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.97,159.6,
"31505 DIAGNOSTIC LARYNGOSCOPY TechFee",231505,CDM,450,RC,C9399,HCPCS,"OUTPATIENT ",,,182,,,121.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",163.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",154.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",109.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.72,172.9,
"31511 LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY TechFee",231511,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,504,,,337.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",134.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",453.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",134.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",141.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",478.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",428.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",302.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",137.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",134.92,478.8,
"31525 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN TechFee",231525,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,601,,,402.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",168.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",160.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",168.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",540.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",160.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",168.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",570.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",510.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",168.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",360.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",164.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",160.89,570.95,
"31530 Laryngoscopy w Fb Removal Tech Fee",231530,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2239.79,,,1500.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",627.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",627.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2015.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",599.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",627.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2127.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1903.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",627.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1343.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",611.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",599.59,2127.8,
"31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC",231575,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,350,,,234.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",93.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",315,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",98.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",93.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",332.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",297.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",210,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",95.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",93.7,332.5,
"31603 TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL TechFee",231603,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1483,,,993.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",415.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",397,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",415.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1334.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",419.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",397,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",415.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1408.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1260.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",415.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",889.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",405.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",397,1408.85,
"31605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE TechFee",231605,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,648,,,434.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",173.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",583.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",183.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",173.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",181.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",615.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",550.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",388.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",176.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",173.47,615.6,
"31612 TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX TechFee",231612,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2613.96,,,1751.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",731.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",699.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",731.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2352.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",739.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",699.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",731.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2483.26,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2221.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",731.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1568.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",713.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",699.76,2483.26,
"31720 CATHETER ASPIRATION NASOTRACHEAL SPX TechFee",231720,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,576,,,385.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",154.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",518.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",162.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",154.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",161.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",547.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",489.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",345.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",157.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",154.2,547.2,
"32551 TUBE THORACOSTOMY INCLUDES WATER SEAL TechFee",232551,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,522,,,349.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",146.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",139.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",146.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",469.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",147.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",139.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",146.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",495.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",443.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",146.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",313.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",142.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",139.74,495.9,
"32554 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING TechFee",232421,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1656,,,1109.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",443.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1490.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",443.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",463.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1573.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1407.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",993.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",452.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",443.31,1573.2,
"32554 Thoracentesis, needle or catheter, aspiration of the pleural space; w/o imaging guidance",632554,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,1656,,,1109.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",443.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1490.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",443.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",463.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1573.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1407.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",993.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",452.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",443.31,1573.2,
"32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING TechFee",232422,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1656,,,1109.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",443.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1490.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",443.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",463.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1573.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1407.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",993.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",452.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",443.31,1573.2,
"32556 ED Tech Fee Pleural drainage, percut, w insert of indwelling cath; w/o image guide",232556,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,990,,,663.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",277.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",265.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",277.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",891,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",279.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",265.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",277.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",940.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",841.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",277.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",594,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",270.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",265.02,940.5,
"32557 US Thoracentesis Cath Placement",1832557,CDM,402,RC,C1713,HCPCS,"OUTPATIENT ",,,1424.28,,,954.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",398.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",381.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",398.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1281.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",381.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",398.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1353.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1210.64,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",398.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",854.57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",388.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",381.28,1353.07,
"36000 INTRODUCTION NEEDLE/INTRACATHETER VEIN TechFee",236000,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2947,,,1974.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",825.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",788.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",825.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2652.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",833.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",788.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",825.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2799.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2504.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",825.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1768.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",804.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",788.91,2799.65,
"36400 VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN TechFee",236400,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,56,,,37.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",50.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",47.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.99,53.2,
"36405 VNPNXR 3 YEARS PHYS/QHP SKILL SCALP VEIN TechFee",236405,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,44,,,29.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",39.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",37.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.02,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.78,41.8,
"36406 Bl Draw < 3 Yrs Other Vein TechFee",236406,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,26,,,17.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",23.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.96,24.7,
"36410 VNPNXR 3 YEARS/> PHYS/QHP SKILL TechFee",236410,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,28,,,18.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",25.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.5,26.6,
"36415  COLLECTION VENOUS BLOOD VENIPUNCTURE TechFee",236415,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,8.45,,,5.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.26,8.03,
"36415 Venipuncture",BO36415,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,8.45,,,5.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.26,8.03,
"36416 Venipuncture (Up to 2 per day) per RN",236416,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,14,,,9.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.75,13.3,
"36430 OPS transfusion of blood or blood components",4036430,CDM,391,RC,C1713,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"36430 TRANSFUSION BLOOD/BLOOD COMPONENTS TechFee",236430,CDM,391,RC,C1713,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> TechFee",236556,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,367,,,245.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",98.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",330.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",103.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",98.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",102.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",348.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",311.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",220.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",100.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",98.25,348.65,
"36561 Insertion of tunneled centrally inserted central venous access device, w/sub port, age 5+",636561,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,1500,,,1005,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",401.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1350,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",424.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",401.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",420,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1425,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1275,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges",900,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",409.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",401.55,1425,
"36569 PICC INSERTION",636569,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,1436.16,,,962.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",384.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1292.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",406.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",384.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",402.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1364.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1220.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",861.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",392.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",384.46,1364.35,
"36589 OPS removal tunnelled central venous access",636589,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,417,,,279.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",111.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",375.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",111.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",116.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",396.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",354.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",250.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",113.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",111.63,396.15,
"36591 BLOOD DRAW FROM IMPLNTD DEVICE CHARGE",BO36591,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,469.5,,,314.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",125.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",422.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",132.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",125.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",131.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",446.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",399.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",281.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",125.69,446.03,
"36591 COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE TechFee",236591,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,469.5,,,314.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",125.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",422.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",132.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",125.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",131.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",446.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",399.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",281.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",125.69,446.03,
"36591 OPS blood collection from implanted port",600084,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,469.5,,,314.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",125.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",422.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",132.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",125.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",131.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",446.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",399.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",281.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",125.69,446.03,
"36591 OPS blood collection of implanted device",600084,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,469.5,,,314.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",125.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",422.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",132.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",125.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",131.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",446.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",399.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",281.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",125.69,446.03,
"36592 COLLECT BLOOD FROM CATHETER VENOUS NOS TechFee",236592,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,115.16,,,77.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",103.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",32.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",109.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",97.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",69.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.83,109.4,
"36592 OPS blood collection from PICC/central line",600083,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,115.16,,,77.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",103.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",32.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",109.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",97.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",69.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.83,109.4,
"36593 DECLOT OF IMPLANTED VASCULAR DEVICE CHARGE",1336593,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,278,,,186.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",77.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",74.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",77.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",250.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",74.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",77.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",264.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",236.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",77.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",166.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",75.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",74.42,264.1,
"36593 DECLOT VASCULAR DEVICE CHARGE",1336593,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,91,,,60.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",77.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.36,86.45,
"36600 ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX TechFee",236600,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,405.26,,,271.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",108.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",364.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",108.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",113.47,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",385,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",344.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges",243.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",108.49,385,
"36620 INSERTION CATHETER ARTERY TechFee",236620,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,433,,,290.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",121.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",115.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",121.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",389.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",122.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",115.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",121.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",411.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",368.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",121.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",259.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",118.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",115.91,411.35,
"36680 PLACEMENT NEEDLE INTRAOSSEOUS INFUSION TechFee",236680,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,244,,,163.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",219.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",231.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",207.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",146.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",66.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.32,231.8,
"37195 ED TECH TPA GIVEN IV",237195,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1711,,,1146.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",479.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",458.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",479.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1539.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",483.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",458.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",479.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1625.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1454.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",479.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1026.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",467.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",458.03,1625.45,
"3M Disposable skin stapler",690603,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,16.83,,,11.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",15.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.71,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.51,15.99,
"3MM KNIFE II",680072,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,12.06,,,8.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",10.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.23,11.46,
"4 BLUE CAST TAPE",690532,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,13.59,,,9.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.23,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.15,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.64,12.91,
"4 COMPRESSION BANDAGE",680119,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,3.99,,,2.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.59,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.39,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.07,3.79,
"4 MEDIPORE TAPE",690203,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,19.86,,,13.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",17.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",16.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5.32,18.87,
"4 PINK CAST TAPE",690535,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,13.53,,,9.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.62,12.85,
"4 X 4 COVADERM",680148,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,3.54,,,2.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.99,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.01,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.95,3.36,
"4 X 4 WHITE CAST TAP",680065,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,12.3,,,8.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.07,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.29,11.69,
"4# LMA PLUS PACK",680094,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,15,,,10.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.02,14.25,
"4.0 BURR OVAL 8 FLUTE",69035,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,206.73,,,138.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",186.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",55.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",196.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",175.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",124.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",56.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",55.34,196.39,
"4-0 PROLENE PS-2 BLU",680159,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,11.1,,,7.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.11,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.97,10.55,
"4-0 VicryL Fs-2 18in",1.11E+14,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,5.31,,,3.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5.04,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.42,5.04,
"40652 REPAIR LIP, FULL THICKNESS TechFee",240652,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,1386,,,928.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",388.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",371.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",388.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1247.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",391.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",371.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",388.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1316.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1178.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",388.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",831.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",378.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",371.03,1316.7,
"40654 RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE TechFee",240654,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,4145,,,2777.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1160.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1109.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1160.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3730.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1172.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1109.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1160.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3937.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3523.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1160.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2487,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1132,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1109.62,3937.75,
"40800 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL TechFee",240800,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,585,,,391.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",526.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",555.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",497.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",351,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.6,555.75,
"40806 VNPNXR INCISION LABIAL FRENUM FRENOTOMY TechFee",240806,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,654,,,438.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",183.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",175.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",183.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",588.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",184.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",175.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",183.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",621.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",555.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",183.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",392.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",178.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",175.08,621.3,
"41115 EXCISION OF TONGUE FOLD",641115,CDM,360,RC,C1776,HCPCS,"OUTPATIENT ",,,10000,,,6700,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677,9500,
"41250 Repair laceration <=2.5cm, floor of mouth and/or anterior two-thirds of tongue",241250,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,760,
"41800 Drainage of Abscess Cyst Hematoma from Dentoalveolar Structures",241800,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,433,,,290.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",121.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",115.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",121.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",389.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",122.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",115.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",121.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",411.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",368.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",121.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",259.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",118.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",115.91,411.35,
"41899 Unlisted procedure, dentoalveolar structures Pro Fee",241899,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,623.49,,,417.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",174.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",166.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",174.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",561.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",176.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",166.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",174.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",592.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",529.97,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",174.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",374.09,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",170.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",166.91,592.32,
"42809 REMOVAL FOREIGN BODY PHARYNX TechFee",242809,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,832,,,557.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",232.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",222.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",232.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",748.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",235.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",222.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",232.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",790.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",707.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",232.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",499.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",227.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",222.73,790.4,
"42820 TONSILLECTOMY AND ADENOIDECTOMY YOUNGER THAN AGE 12",642820,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"42821 REMOVE TONSILS AND ADENOIDS",642821,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"42825 Tonsillectomy, primary or secondary; younger than age 12",642825,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"42826 REMOVAL OF TONSILS",642826,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"42831 REMOVAL OF ADENOIDS",642831,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"42970 CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS",242970,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,648,,,434.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",173.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",583.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",183.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",173.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",181.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",615.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",550.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",388.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",176.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",173.47,615.6,
"42999 Throat, adenoids, or tonsils procedure",242999,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,700,,,469,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",187.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",630,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",197.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",187.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",196,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",665,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",595,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges",420,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",191.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",187.39,665,
"43220 ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION (LESS THAN 3 ProFee",643220,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,762,,,510.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",213.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",203.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",213.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",685.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",215.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",203.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",213.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",723.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",647.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",213.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",457.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",208.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",203.99,723.9,
"43233 EGD BALLOON DILATION",643233,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,3981.97,,,2667.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1114.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1065.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1114.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3583.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1126.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1065.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1114.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3782.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3384.67,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1114.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2389.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1087.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1065.97,3782.87,
"43239 EGD W/BIOPSY",610064,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,7846.65,,,5257.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2197.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2100.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2197.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7061.99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2219.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2100.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2197.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7454.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6669.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2197.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4707.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2142.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2100.55,7454.32,
"43246 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(",643246,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4628.68,,,3101.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1296.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1239.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1296.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4165.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1308.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1239.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1296.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4397.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3934.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1296.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2777.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1264.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1239.1,4397.25,
"43246 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERCUTANEO TechFee",643246,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4628.68,,,3101.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1296.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1239.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1296.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4165.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1308.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1239.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1296.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4397.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3934.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1296.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2777.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1264.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1239.1,4397.25,
"43247 GASTRO W/REMOVAL OF FOREIGN BODY Charges",643247,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4035.07,,,2703.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1129.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1080.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1129.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3631.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1141.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1080.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1129.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3833.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3429.81,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1129.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2421.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1101.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1080.19,3833.32,
"43248 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED TechFee",643248,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4548.73,,,3047.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1273.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1217.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1273.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4093.86,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1286.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1217.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1273.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4321.29,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3866.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1273.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2729.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1242.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1217.7,4321.29,
"43249 EGD W/ BALLOON DILATION Charge",643249,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,4517.97,,,3027.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1209.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4066.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1277.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1209.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4292.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3840.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2710.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1233.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1209.46,4292.07,
"43251 EGD W/SNARE POLYPECTOMY Charges",643251,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4458.97,,,2987.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1248.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1193.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1248.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4013.07,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1261,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1193.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1248.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4236.02,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3790.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1248.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2675.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1217.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1193.67,4236.02,
"43255 ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD TechFee",643255,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4636.73,,,3106.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1298.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1241.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1298.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4173.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1311.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1241.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1298.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4404.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3941.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1298.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2782.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1266.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1241.25,4404.89,
"43450 DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES TechFee",643450,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,888.3,,,595.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",248.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",248.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",799.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",251.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",237.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",248.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",843.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",755.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",248.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",532.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",242.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.8,843.89,
"43752 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE TechFee",243752,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,179,,,119.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",161.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",170.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",152.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",107.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.92,170.05,
"43753 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE TechFee",243753,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,337,,,225.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",303.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",320.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",286.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",202.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.21,320.15,
"43761 REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO",243761,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1240,,,830.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",331.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1116,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",350.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",331.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",347.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1178,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1054,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",744,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",338.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",331.95,1178,
"43762 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC TechFee",243762,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,825,,,552.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",231,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",220.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",231,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",742.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",233.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",220.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",231,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",783.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",701.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",231,28,,,,,0,"percent of total billed charges ","28% of total billed charges",495,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",225.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",220.85,783.75,
"43763 PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC TechFee",243763,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1209,,,810.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",338.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",323.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",338.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1088.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",341.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",323.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",338.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1148.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1027.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",338.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",725.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",330.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",323.65,1148.55,
"44388 COLONOSCOPY THROUGH STOMA; DIAGNOSTIC",644388,CDM,750,RC,C1776,HCPCS,"OUTPATIENT ",,,5531.24,,,3705.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1548.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1480.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1548.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4978.12,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1564.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1480.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1548.75,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5254.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4701.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1548.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3318.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1510.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1480.71,5254.68,
"44970 LAPAROSCOPY APPENDECTOMY",644970,CDM,360,RC,C1776,HCPCS,"OUTPATIENT ",,,1791,,,1199.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",501.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",479.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",501.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1611.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",506.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",479.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",501.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1701.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1522.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",501.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1074.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",489.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",479.45,1701.45,
"45172 EXC RCT TUM INCL MUSCULARIS PROPRIA Tech Charge",645172,CDM,360,RC,C1776,HCPCS,"OUTPATIENT ",,,2200,,,1474,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",616,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",588.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",616,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1980,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",622.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",588.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",616,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2090,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1870,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",616,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",600.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",588.94,2090,
"45300 Proctosigmoidoscopy, rigid",645300,CDM,750,RC,C1776,HCPCS,"OUTPATIENT ",,,3872.78,,,2594.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1084.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1036.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1084.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3485.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1095.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1036.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1084.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3679.14,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3291.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1084.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2323.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1057.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1036.74,3679.14,
"45331 SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE TechFee",645331,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,3872,,,2594.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1084.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1036.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1084.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3484.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1095,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1036.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1084.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3678.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3291.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1084.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2323.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1057.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1036.53,3678.4,
"45338 Sigmoidoscopy, Flexible; w/ Removal Tumor(s), Polyp(s), or Other Lesion(s) by Snare Technique",645338,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,684,,,458.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",191.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",183.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",191.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",615.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",193.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",183.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",191.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",649.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",581.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",191.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",410.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",186.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",183.11,649.8,
"45380 Colonoscopy with biopsy, single or multiple TechFee",610066,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4387.51,,,2939.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1228.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1174.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1228.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3948.76,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1240.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1174.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1228.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4168.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3729.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1228.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2632.51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1198.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1174.54,4168.13,
"45381 COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S)",645381,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4636.28,,,3106.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1298.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1241.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1298.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4172.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1311.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1241.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1298.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4404.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3940.84,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1298.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2781.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1266.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1241.13,4404.47,
"45384 COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT Bx",645384,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,4705.97,,,3153,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4235.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4470.67,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4000.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2823.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1285.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1259.79,4470.67,
"45385 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ",645385,CDM,750,RC,C1713,HCPCS,"OUTPATIENT ",,,7791.3,,,5220.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2181.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2085.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2181.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",7012.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2203.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2085.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2181.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7401.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6622.61,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2181.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4674.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2127.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2085.73,7401.74,
"45915 Removal of fecal impaction or foreign body (separate procedure) under anesthesia",645915,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,630,,,422.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",168.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",567,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",168.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",176.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",598.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",535.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",378,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",168.65,598.5,
"45915 RMVL FECAL IMPACTION/FB SPX UNDER ANES TechFee",245915,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,630,,,422.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",168.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",567,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",168.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",176.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",598.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",535.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",378,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",168.65,598.5,
"4'6- 5'2 CRUTCHES",680153,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,109.89,,,73.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",98.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.42,104.4,
"46040 I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX TechFee",246040,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,4616,,,3092.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1292.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1235.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1292.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4154.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1305.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1235.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1292.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4385.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3923.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1292.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2769.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1260.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1235.7,4385.2,
"46050 I&D PERIANAL ABSCESS SUPERFICIAL TechFee",246050,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,605,,,405.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",169.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",161.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",169.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",544.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",171.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",161.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",169.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",574.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",514.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",169.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",363,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",165.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",161.96,574.75,
"46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) TechFee",610215,CDM,361,RC,C1713,HCPCS,"OUTPATIENT ",,,3545.69,,,2375.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",992.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",949.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",992.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3191.12,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1002.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",949.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",992.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3368.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3013.84,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",992.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2127.41,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",968.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",949.18,3368.41,
"47000 Biopsy of liver, needle",647000,CDM,490,RC,C1713,HCPCS,"OUTPATIENT ",,,380,,,254.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",101.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",342,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",107.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",101.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",361,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",323,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",228,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",103.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",101.73,361,
"49440 INSERTION OF GASTROSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDING CON TechFee",249440,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1456,,,975.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",407.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",389.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",407.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1310.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",411.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",389.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",407.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1383.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1237.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",407.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",873.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",397.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",389.77,1383.2,
"5.0 CUFFED ET TUBE",680108,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,5.7,,,3.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5.42,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.53,5.42,
"5.0 UNCUFFED ET TUBE",680107,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,4.8,,,3.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.28,4.56,
"5-0 FAST-ABSORBING P",680111,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,14.91,,,9.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.17,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.67,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.95,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.99,14.16,
"51700 BLDR IRRIGATION SMPL LAVAGE &/INSTLJ TechFee",251700,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,180,,,120.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",162,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",171,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",153,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",108,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.19,171,
"51701 INSJ NON-NDWELLG BLADDER CATHETER TechFee",251701,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,345,,,231.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",92.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",310.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",92.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",96.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",327.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",293.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",207,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",94.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",92.36,327.75,
"51702 INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE TechFee",251702,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,345,,,231.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",92.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",310.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",92.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",96.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",327.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",293.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",96.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",207,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",94.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",92.36,327.75,
"51705 CHANGE CYSTOSTOMY TUBE SIMPLE TechFee",251705,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.23,213.75,
"54220 IRRIGATE CORPORA CAVERNOSA FOR PRIAPISM",254220,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,448.4,
"54450 FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING TechFee",254450,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,166,,,111.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",149.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",46.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",157.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",141.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",99.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.44,157.7,
"54700 ED INCISION AND DRAINAGE EPIDIDYMIS TSTIS&/SCROTAL SPACE TechFee",254700,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,564,,,377.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",157.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",150.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",157.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",507.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",159.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",150.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",157.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",535.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",479.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",157.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",338.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",154.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",150.98,535.8,
"55100 Drainage of scrotal wall abscess TechFee",255100,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1836,,,1230.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",514.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",491.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",514.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1652.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",519.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",491.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",514.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1744.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1560.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",514.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1101.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",501.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",491.5,1744.2,
"56405 I&D VULVA/PERINEAL ABSCESS TechFee",256405,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,478,,,320.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",133.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",127.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",133.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",430.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",127.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",133.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",454.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",406.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",133.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",286.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",130.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",127.96,454.1,
"56420 I&D OF BARTHOLINS GLAND ABSCESS TechFee",256420,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,798,,,534.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",223.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",213.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",223.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",718.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",225.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",213.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",223.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",758.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",678.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",223.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",478.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",217.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",213.62,758.1,
"59409 VAGINAL DELIVERY ONLY TechFee",259409,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2214,,,1483.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",619.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",592.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",619.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1992.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",626.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",592.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",619.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2103.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1881.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",619.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1328.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",604.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",592.69,2103.3,
"59414 DELIVERY PLACENTA SEPARATE PROCEDURE TechFee",259414,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2166.32,,,1451.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",606.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",579.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",606.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1949.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",612.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",579.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",606.57,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2058,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1841.37,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",606.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1299.79,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",591.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",579.92,2058,
"5-HIAA,Quant.,24 Hr Urine LC",2283497,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,120,,,80.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",108,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",33.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",33.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",114,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",102,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.12,114,
"5X100MM KII Z- THREA",680182,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,294,,,196.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",82.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",78.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",82.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",264.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",83.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",78.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",82.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",279.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",249.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",82.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",176.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",80.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",78.7,279.3,
"6  COMPRESSION BANDAGE",680120,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,6.81,,,4.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",6.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4.09,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.82,6.47,
"6 ESMARK",664432,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,14.43,,,9.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.86,13.71,
"6 STERILE ACE",610121,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,2.67,,,1.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.75,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.71,2.54,
"6-0 PROLENE BV",680236,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,114.54,,,76.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",103.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",32.07,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",97.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.66,108.81,
"6-0 PROLENE BV-1",680235,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,57.78,,,38.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",52,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",16.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",49.11,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",15.47,54.89,
"62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC TechFee",262270,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2280,,,1527.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",638.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",610.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",638.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2052,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",644.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",610.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",638.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2166,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1938,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",638.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1368,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",622.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",610.36,2166,
"62270-Lumbar Puncture Diagnostic TechFee",262270,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2280,,,1527.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",638.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",610.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",638.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2052,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",644.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",610.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",638.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2166,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1938,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",638.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1368,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",622.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",610.36,2166,
"62273 Injection, epidural, of blood or clot patch",662273,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,706,,,473.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",189,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",635.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",189,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",670.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",600.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",423.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",189,670.7,
"62321 INJ CERVICAL/THORACIC EPIDURAL W IMAGE",662321,CDM,361,RC,C1713,HCPCS,"OUTPATIENT ",,,1500,,,1005,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",401.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1350,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",424.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",401.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",420,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1425,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1275,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges",900,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",409.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",401.55,1425,
"62322  Injection(s), of diagnostic/therapeutic substance(s); interlaminar epidural or subarachnoid,",662322,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,2610,,,1748.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",730.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",698.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",730.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2349,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",738.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",698.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",730.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2479.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2218.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",730.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1566,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",712.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",698.7,2479.5,
"64400 INJECTION, ANESTHETIC AGENT TechFee",264400,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,288,,,192.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",77.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",259.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",77.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",80.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",273.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",244.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",172.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",78.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",77.1,273.6,
"64417 Njx aa&/strd axillary nrv",264417,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,594,,,397.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",534.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",167.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",564.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",504.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",356.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.01,564.3,
"64447 FEMORAL NERVE BLOCK TECH FEE",664447,CDM,370,RC,C1713,HCPCS,"OUTPATIENT ",,,987.5,,,661.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",276.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",264.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",276.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",888.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",279.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",264.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",276.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",938.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",839.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",276.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",592.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",269.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",264.35,938.13,
"64450 ED Tech Inject Anesthetic Agent, Other Peripheral Nerve or Branch",264450,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,750,,,502.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",675,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",212.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",200.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",210,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",712.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",637.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges",450,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",204.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.78,712.5,
"64483 Lumbar/Sacral Epidural - Transforaminal",O664483,CDM,361,RC,C1713,HCPCS,"OUTPATIENT ",,,1093,,,732.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",306.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",292.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",306.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",983.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",309.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",292.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",306.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1038.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",929.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",306.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",655.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",298.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",292.6,1038.35,
"64486 TAP Block Unilateral (Transversus Abdominis Plane) (Includes Imaging Guidance)",664486,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,795,,,532.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",212.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",715.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",224.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",212.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",222.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",755.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",675.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",477,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",217.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",212.82,755.25,
"64488 INJECTION, ANES AGENT TAP BLOCK-UNILATERAL W/ IMAGE GUID IF USED",664488,CDM,370,RC,C1713,HCPCS,"OUTPATIENT ",,,3231,,,2164.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",904.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",864.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",904.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2907.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",913.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",864.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",904.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3069.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2746.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",904.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1938.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",882.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",864.94,3069.45,
"64488 TAP Block Bilateral (Transversus Abdominis Plane) (Includes Imaging Guidance)",664488,CDM,370,RC,C1776,HCPCS,"OUTPATIENT ",,,3231,,,2164.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",904.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",864.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",904.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2907.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",913.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",864.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",904.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3069.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2746.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",904.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1938.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",882.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",864.94,3069.45,
"64634 Radiofrequency ablation (RFA) ? cervical or thoracic (each additional joint)",664634,CDM,360,RC,C1776,HCPCS,"OUTPATIENT ",,,986,,,660.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",276.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",263.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",276.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",887.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",278.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",263.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",276.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",936.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",838.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",276.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",591.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",269.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",263.95,936.7,
"64636 Radiofrequency ablation (RFA) ? lumbar or sacral (each additional joint)",664636,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,531,,,355.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",148.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",142.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",148.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",477.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",150.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",142.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",148.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",504.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",451.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",148.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",318.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",145.02,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",142.15,504.45,
"64718 ULNAR NERVE TRANSP",664718,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,3481,,,2332.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",974.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",931.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",974.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3132.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",984.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",931.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",974.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3306.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2958.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",974.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2088.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",950.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",931.86,3306.95,
"64999 BLOCK ERECTOR SPINAE",664999,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,850,,,569.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",227.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",765,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",227.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",238,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",807.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",722.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges",510,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",232.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",227.55,807.5,
"64999 UNLISTED PROCEDURE NERVOUS SYSTEM TechFee",264999,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,850,,,569.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",227.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",765,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",227.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",238,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",807.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",722.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges",510,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",232.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",227.55,807.5,
"65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL TechFee",265205,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,222,,,148.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",199.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",62.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",210.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",188.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",133.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",60.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59.43,210.9,
"65210 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR TechFee",265210,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,832,,,557.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",232.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",222.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",232.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",748.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",235.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",222.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",232.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",790.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",707.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",232.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",499.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",227.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",222.73,790.4,
"65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP TechFee",265220,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,656,,,439.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",183.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",175.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",183.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",590.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",185.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",175.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",183.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",623.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",557.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",183.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",393.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",179.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",175.61,623.2,
"65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP TechFee",265222,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,181,,,121.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",162.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",171.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",153.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",108.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.45,171.95,
"65820 Goniotomy",665820,CDM,360,RC,C1776,HCPCS,"OUTPATIENT ",,,2032,,,1361.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",568.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",543.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",568.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1828.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",574.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",543.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",568.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1930.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1727.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",568.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1219.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",554.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",543.97,1930.4,
"66850 REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, ProFee",666850,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,1997,,,1337.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",559.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",534.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",559.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1797.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",564.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",534.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",559.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1897.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1697.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",559.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1198.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",545.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",534.6,1897.15,
"66982 CAT EXT W/IRIS RETRACTOR",666982,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,2120.86,,,1420.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",593.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",567.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",593.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1908.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",599.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",567.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",593.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2014.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1802.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",593.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1272.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",579.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",567.75,2014.82,
"66986 Exchange of intraocular lens",666986,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,2093,,,1402.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",586.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",560.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",586.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1883.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",591.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",560.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",586.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1988.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1779.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",586.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1255.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",571.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",560.3,1988.35,
"67005 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIA ProFee",667005,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,1563,,,1047.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",437.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",418.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",437.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1406.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",442.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",418.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",437.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1484.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1328.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",437.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",937.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",426.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",418.42,1484.85,
"67700 ED DRAINAGE OF EYELID ABSCESS TechFee",267700,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,561,,,375.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",157.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",150.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",157.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",504.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",158.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",150.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",157.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",532.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",476.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",157.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",336.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",153.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",150.18,532.95,
"67800 EXCISION CHALAZION SINGLE TechFee",267800,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,801,,,536.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",720.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.43,760.95,
"67938 REMOVAL EMBEDDED FOREIGN BODY EYELID TechFee",267938,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,363,,,243.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",101.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",97.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",101.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",326.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",102.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",97.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",101.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",344.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",308.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",101.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",217.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",99.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",97.18,344.85,
"69000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPL",269000,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,1228,,,822.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",343.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",328.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",343.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1105.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",347.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",328.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",343.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1166.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1043.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",343.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",736.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",335.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",328.74,1166.6,
"69005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX TechFee",269005,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,562,,,376.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",157.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",150.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",157.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",505.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",158.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",150.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",157.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",533.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",477.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",157.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",337.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",153.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",150.45,533.9,
"69020 DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS",269020,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,533,,,357.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",149.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",142.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",149.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",479.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",150.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",142.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",149.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",506.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",453.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",149.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",319.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",145.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",142.68,506.35,
"69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES TechFee",269200,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,517,,,346.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",465.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",146.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",491.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",439.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",310.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",141.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.4,491.15,
"69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL TechFee",269209,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,31,,,20.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",27.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",26.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8.3,29.45,
"69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee",269210,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,422,,,282.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",379.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",400.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",358.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.97,400.9,
"69421 INCISION OF EARDRUM",669421,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"69424 REMOVE VENTILATING TUBE",669424,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"69436 Tympanostomy (requiring insertion of ventilation tube), general anesthesia",669436,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,10000,,,6700,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677,9500,
"69610 REPAIR OF EARDRUM",669610,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,10000,,,6700,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677,9500,
"69620 Myringoplasty (surgery confined to drumhead and donor area)",669620,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"69631 Tympanoplasty w/o mastoidectomy, initial or revision; without ossicular chain reconstruction",669631,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69632 Tympanoplasty w/o mastoidectomy, initial or revision; with ossicular chain reconstruction",669632,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69633 Tympanoplasty w/o mastoidectomy, initial or revision; with PORP, TORP",669633,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69635 Tympanoplasty with antrotomy or mastoidotomy; without ossicular chain reconstruction",669635,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69636 Tympanoplasty with antrotomy or mastoidotomy; with ossicular chain reconstruction",669636,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69637 Tympanoplasty with antrotomy or mastoidotomy; with PORP, TORP",669637,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69641 Tympanoplasty, w/ mastoidectomy; w/o ossicular chain reconstruction",669641,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69642 Tympanoplasty, w/ mastoidectomy; w/ ossicular chain reconstruction",669642,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69643 Tympanoplasty, w/ mastoidectomy; w/ intact wall, w/o ossicular chain reconstruction",669643,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69644 Tympanoplasty, w/ mastoidectomy; w/ intact canal wall, w/ ossicular chain reconstruction",669644,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69645 Tympanoplasty w/ mastoidectomy; radical or complete, without ossicular chain reconstruction",669645,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"69646 Tympanoplasty, w/ mastoidectomy; radical or complete, w/ ossicular chain reconstruction",669646,CDM,360,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"6F Introducer Kit/ sheath",680002,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,675,,,452.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",189,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",180.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",189,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",607.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",190.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",180.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",189,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",641.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",573.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",189,28,,,,,0,"percent of total billed charges ","28% of total billed charges",405,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",184.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",180.7,641.25,
"7' NASAL CANNULA",260026,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,0.93,,,0.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",0.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",63.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",0.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",0.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",0.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.25,63.61,
"7.5 ET TUBE",680109,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,5.7,,,3.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5.42,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.53,5.42,
"70MM AIRWAY",680192,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,1.56,,,1.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",0.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.42,1.48,
"71250 CT Chest w/o Contrast",1671250,CDM,352,RC,C1713,HCPCS,"OUTPATIENT ",,,2837,,,1900.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",794.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",759.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",794.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2553.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",802.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",759.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",794.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2695.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2411.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",794.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1702.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",774.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",759.46,2695.15,
"71260 CT Chest w/ Contrast",1671260,CDM,352,RC,C1713,HCPCS,"OUTPATIENT ",,,4481.5,,,3002.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1254.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1199.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1254.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4033.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1267.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1199.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1254.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4257.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3809.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2688.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1223.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1199.7,4257.43,
"71270 CT Chest w/ + w/o Contrast",1671270,CDM,352,RC,C1713,HCPCS,"OUTPATIENT ",,,3696.1,,,2476.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1034.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",989.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1034.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3326.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1045.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",989.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1034.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3511.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3141.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1034.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2217.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1009.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",989.45,3511.3,
"71275 CT Angio Chest",1671275,CDM,352,RC,C1713,HCPCS,"OUTPATIENT ",,,6904.5,,,4626.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1848.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",6214.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1952.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1848.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1933.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6559.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5868.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4142.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1885.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1848.33,6559.28,
"726778 7+Alc-Unbund LC",2280307,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",50.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",50.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",50.53,179.32,
"733726 13+Oxycodone+Crt-Scr LC",2280307,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",50.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",50.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",50.53,179.32,
"74248 Small Bowel Series",1474248,CDM,320,RC,C1776,HCPCS,"OUTPATIENT ",,,302,,,202.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",271.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",85.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",286.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",256.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",181.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",82.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.85,286.9,
"75577 Coronary Plaque Analysis",1675577,CDM,350,RC,C1776,HCPCS,"OUTPATIENT ",,,3800,,,2546,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1017.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3420,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1074.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1017.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1064,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3610,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3230,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2280,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1037.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1017.26,3610,
"75580 FFR-CT",1675580,CDM,350,RC,C1776,HCPCS,"OUTPATIENT ",,,3980,,,2666.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1065.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3582,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1125.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1065.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1114.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3781,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3383,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2388,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1086.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1065.45,3781,
"764888 10+Oxyco+Alc+Crt-Bund LC",2280307,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",50.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",50.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",50.53,179.32,
"7mm Bone Graft Harvester",691443,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,2595,,,1738.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",726.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",694.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",726.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2335.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",733.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",694.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",726.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2465.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2205.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",726.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1557,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",708.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",694.68,2465.25,
"80CM EMBOLECTOMY CAT",680085,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,217.8,,,145.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",60.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",60.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",196.02,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",61.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",58.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",60.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",206.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",185.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",60.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",130.68,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",59.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",58.31,206.91,
"82948 GLUCOSE BLOOD REAGENT STRIP TechFee",282948,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.31,43.7,
"88108 AP Bill Cytopath concentrate tech",SEPA88108,CDM,310,RC,C1776,HCPCS,"OUTPATIENT ",,,104,,,69.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",93.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",29.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",98.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",88.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",62.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.84,98.8,
"88112 AP Bill Cytopath cell enhance tech",SEPA88112,CDM,311,RC,C1776,HCPCS,"OUTPATIENT ",,,445,,,298.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",124.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",124.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",400.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",125.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",124.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",422.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",378.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",124.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",267,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",121.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.13,422.75,
"88300 AP Bill Surgical Pathology Level I Complexity",SEPA88300,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",50.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",50.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",50.06,177.65,
"88302 AP Bill Surgical Pathology Level II Complexity",SEPA88302,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,71,,,47.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",60.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.01,67.45,
"88304 AP Bill Surgical Pathology Level III Complexity",SEPA88304,CDM,312,RC,C1713,HCPCS,"OUTPATIENT ",,,122.85,,,82.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",110.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",116.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",104.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.89,116.71,
"88305 AP Bill Surgical Pathology Level IV Complexity",SEPA88305,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,105.3,,,70.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",94.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",28.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",29.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",100.04,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",89.51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",28.19,100.04,
"88307 AP Bill Surgical Pathology Level V Complexity",SEPA88307,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,376.65,,,252.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",105.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",105.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",338.99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",100.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",105.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",357.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",320.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",105.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",225.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",102.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.83,357.82,
"88309 AP Bill Surgical Pathology Level VI Complexity",SEPA88309,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,1067,,,714.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",298.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",285.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",298.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",960.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",301.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",285.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",298.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1013.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",906.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",298.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",640.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",291.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",285.64,1013.65,
"88312 AP Bill Special Stain Group 1 Microorganisms I&R",SEPA88312,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,317.7,,,212.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",88.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",88.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",285.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",85.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",88.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",301.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",270.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",88.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",190.62,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",86.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",85.05,301.82,
"88341 AP Bill Surg IPX (Add'l Antibody)",SEPA88341,CDM,312,RC,C1713,HCPCS,"OUTPATIENT ",,,122.85,,,82.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",110.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",116.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",104.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.89,116.71,
"88342 AP Bill Surg IPX (First Antibody)",SEPA88342,CDM,312,RC,C1713,HCPCS,"OUTPATIENT ",,,146.25,,,97.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.94,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.15,138.94,
"88344 AP Bill Surg IPX (Multiplex Stain)",SEPA88344,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,720,,,482.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",201.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",192.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",201.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",648,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",203.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",192.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",201.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",684,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",612,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",201.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",432,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",196.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",192.74,684,
"88360 AP Bill Tumor immunohistochem/manual",SEPA88360,CDM,310,RC,L8642,HCPCS,"OUTPATIENT ",,,607,,,406.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",169.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",162.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",169.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",546.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",171.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",162.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",169.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",576.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",515.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",169.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",364.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",165.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",162.49,576.65,
"88361 AP Bill Computer immunohistochem Quant",SEPA88361,CDM,310,RC,L8642,HCPCS,"OUTPATIENT ",,,926.55,,,620.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",259.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",259.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",833.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",262.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",259.43,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",880.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",787.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",259.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges",555.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.04,880.22,
"88364 Insitu Hybridization, ea addl",SEPA88364,CDM,310,RC,C1776,HCPCS,"OUTPATIENT ",,,647,,,433.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",181.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",173.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",181.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",582.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",182.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",173.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",181.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",614.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",549.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",181.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",388.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",176.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",173.2,614.65,
"88365 AP Bill Insitu hybridization, 1st Probe",SEPA88365,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,872,,,584.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",244.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",233.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",244.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",784.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",246.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",233.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",244.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",828.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",741.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",244.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",523.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",238.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",233.43,828.4,
"88374 AP Bill Computer Assist Morph Analysis, Mult Probe",SEPA88374,CDM,312,RC,C1713,HCPCS,"OUTPATIENT ",,,879.12,,,589.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",246.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",235.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",246.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",791.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",248.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",235.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",246.15,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",835.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",747.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",246.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges",527.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",240.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",235.34,835.16,
"88377 AP Bill AP Bill Manual Morph Analysis,Mult Probe",SEPA88377,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,1222,,,818.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",342.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",327.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",342.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1099.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",345.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",327.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",342.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1160.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1038.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",342.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",733.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",333.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",327.13,1160.9,
"88381 AP Bill Microdissection manual",SEPA88381,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,1202,,,805.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",336.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",321.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",336.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1081.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",339.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",321.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",336.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1141.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1021.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",336.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",721.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",328.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",321.78,1141.9,
"8mm Bioimplant, Evans Bone Wedge",691442,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"90460  IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX TechFee",290460,CDM,771,RC,C1713,HCPCS,"OUTPATIENT ",,,47,,,31.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",42.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",13.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",44.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",39.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",28.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.58,44.65,
"90461  IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT TechFee",290461,CDM,771,RC,C9353,HCPCS,"OUTPATIENT ",,,36,,,24.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",32.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9.64,34.2,
"90471  IM ADM PRQ ID SUBQ IM NJXS 1 VACCINE TechFee",290471,CDM,771,RC,C1763,HCPCS,"OUTPATIENT ",,,85.05,,,56.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",76.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",80.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",72.29,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",51.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.77,80.8,
"90471 Admin Charge",290471,CDM,771,RC,C1713,HCPCS,"OUTPATIENT ",,,94.5,,,63.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",89.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",56.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.3,89.78,
"90471 IMMUNIZATION ADMIN 1 VAC Charge",INF90471,CDM,771,RC,C9353,HCPCS,"OUTPATIENT ",,,94.5,,,63.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",89.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",56.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.3,89.78,
"90471 OPS immunization administration",4090471,CDM,771,RC,C9353,HCPCS,"OUTPATIENT ",,,94.5,,,63.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",89.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",56.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.3,89.78,
"90472  IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE TechFee",290472,CDM,771,RC,C9353,HCPCS,"OUTPATIENT ",,,89,,,59.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",80.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.83,84.55,
"90473  IM ADM INTRANSL/ORAL 1 VACCINE TechFee",290473,CDM,771,RC,C9353,HCPCS,"OUTPATIENT ",,,88,,,58.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",79.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",83.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",74.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",52.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.56,83.6,
"90658  VACCINATION FLU> 3YO CHARGE",1390658,CDM,636,RC,C9353,HCPCS,"OUTPATIENT ",,,81,,,54.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",81,100,,,,,0,"fee schedule","100% of total billed charges",72.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",22.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",76.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",68.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",48.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",21.68,81,
"90675 RABIES VACCINE IM TechFee",290675,CDM,636,RC,C9353,HCPCS,"OUTPATIENT ",,,1445.73,,,968.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",404.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",387.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",404.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",722.87,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1301.16,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",408.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",387.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",404.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1373.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1228.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",404.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",867.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",394.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",387.02,1373.44,
"90792 Psychiatric diagnostic Evaluation - with medical services Charge",2090792,CDM,900,RC,C1785,HCPCS,"OUTPATIENT ",,,425,,,284.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",382.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",63.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",403.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",361.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.61,403.75,
"90832 Psychotherapy, 30 min Charge",2090832,CDM,914,RC,A6245,HCPCS,"OUTPATIENT ",,,125.28,,,83.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",63.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.02,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.49,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.17,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.54,119.02,
"92508  - Speech Therapy Group Charge",4202063,CDM,440,RC,A6246,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.85,
"92611 FLUOROSCOPIC EVALUATION OF SWALLOWING UN CHARGE.",4292611,CDM,440,RC,A6243,HCPCS,"OUTPATIENT ",,,621,,,416.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",166.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",558.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",166.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",173.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",589.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",527.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",372.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",169.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",166.24,589.95,
"92950 CARDIOPULMONARY RESUSCITATION TechFee",292950,CDM,450,RC,C1781,HCPCS,"OUTPATIENT ",,,1054.56,,,706.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",282.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",949.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",298.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",282.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",295.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1001.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",896.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",632.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",288,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",282.31,1001.83,
"92950 CPR CHARGE",2614001,CDM,410,RC,G0416,HCPCS,"OUTPATIENT ",,,1054.56,,,706.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",282.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",949.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",298.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",282.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",295.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1001.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",896.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",632.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",288,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",282.31,1001.83,
"92953 Temporary External Pacing TechFee",292953,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,468,,,313.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",131.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",125.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",131.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",421.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",132.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",125.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",131.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",444.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",397.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",131.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",280.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",127.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",125.28,444.6,
"92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee",292960,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,4555,,,3051.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1219.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4099.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1288.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1219.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1275.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4327.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3871.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2733,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1243.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1219.37,4327.25,
"93000 EKG w/interpretation and report",2693000,CDM,730,RC,C1713,HCPCS,"OUTPATIENT ",,,72.5,,,48.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",65.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",68.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",61.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.41,68.88,
"93005 EKG w/ 12+ leads; Tracing Only",CL93005,CDM,730,RC,C9359,HCPCS,"OUTPATIENT ",,,29,,,19.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",26.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",24.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.76,27.55,
"93005 EKG, Tracing Only",RHC93005,CDM,730,RC,C1713,HCPCS,"OUTPATIENT ",,,29,,,19.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",26.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",24.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.76,27.55,
"93015 Cardiovascular stress test, complete; with supervision, interpretation and report",2693015,CDM,482,RC,C1713,HCPCS,"OUTPATIENT ",,,2832.5,,,1897.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",758.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2549.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",801.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",758.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",793.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2690.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2407.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1699.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",773.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",758.26,2690.88,
"93015 STRESS TEST INTERP REPORT CHARGE",2693015,CDM,482,RC,C1713,HCPCS,"OUTPATIENT ",,,2832.5,,,1897.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",758.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2549.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",801.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",758.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",793.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2690.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2407.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1699.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",773.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",758.26,2690.88,
"93017 Cardiovascular stress test; tracing only, without interpretation and report",2693017,CDM,482,RC,C1897,HCPCS,"OUTPATIENT ",,,1467.18,,,983.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",410.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",392.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",410.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1320.46,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",414.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",392.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",410.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1393.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1247.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",410.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",880.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",400.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",392.76,1393.82,
"93017 STRESS TEST TRACING ONLY CHARGE",2693017,CDM,482,RC,C1897,HCPCS,"OUTPATIENT ",,,1467.18,,,983.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",410.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",392.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",410.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1320.46,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",414.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",392.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",410.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1393.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1247.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",410.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",880.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",400.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",392.76,1393.82,
"93227 HOLTER MONITOR 24/48 HRS INTERPRETATION CHARGE",2693227,CDM,731,RC,T4524,HCPCS,"OUTPATIENT ",,,103,,,69.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",92.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",97.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",87.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",61.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.57,97.85,
"93242 Holter Hook UP 3 to 7 days",CL93242,CDM,450,RC,T4523,HCPCS,"OUTPATIENT ",,,38,,,25.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",34.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",36.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",32.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.17,36.1,
"93246 Holter Hook Up 8 to 15 days",CL93246,CDM,450,RC,T4522,HCPCS,"OUTPATIENT ",,,38,,,25.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",34.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",36.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",32.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.17,36.1,
"93312 ECHO-TRANSESOPHAGEAL CHARGE",2693312,CDM,483,RC,C1713,HCPCS,"OUTPATIENT ",,,1422,,,952.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",380.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1279.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",380.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",398.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1350.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1208.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",853.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",388.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",380.67,1350.9,
"94002 MECHANICAL VENTILATOR INITIAL SET CHARGE",2615007,CDM,410,RC,C1713,HCPCS,"OUTPATIENT ",,,497.54,,,333.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",139.31,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",133.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",139.31,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",447.79,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",140.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",133.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",139.31,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",472.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",422.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",139.31,28,,,,,0,"percent of total billed charges ","28% of total billed charges",298.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",135.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",133.19,472.66,
"94640 MED NEB INITIAL CHARGE",2612011,CDM,410,RC,C1713,HCPCS,"OUTPATIENT ",,,203,,,136.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",182.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",192.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",172.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.34,192.85,
"94640 MED NEB SUBSEQUENT CHARGE",2612012,CDM,410,RC,C1713,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"94644 CONTINUOUS INHALATION TREATMENT - 1ST HOUR",2616010,CDM,410,RC,A4344,HCPCS,"OUTPATIENT ",,,250.38,,,167.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.11,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150.23,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.03,237.86,
"94660 BIPAP TREATMENT INITIATION Charge",2415007,CDM,410,RC,A4352,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"94660 BIPAP TREATMENT SUBSEQUENT Charge",2415008,CDM,410,RC,A4344,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"94660 CPAP MAINTENANCE PER DAY CHARGE",2694660,CDM,410,RC,A4346,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"94664 DEMO FOR HOME AEROSOL OR MDI CHARGE",2694664,CDM,410,RC,A4344,HCPCS,"OUTPATIENT ",,,176.22,,,118.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",158.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",167.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",149.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",105.73,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.17,167.41,
"94668 CHEST PHYSIOTHERAPY SUBSEQUENT CHARGE",2611008,CDM,410,RC,A4344,HCPCS,"OUTPATIENT ",,,122,,,81.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",109.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",103.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.66,115.9,
"94760 PULSE OXIMETRY SINGLE CHARGE",2694760,CDM,460,RC,A4344,HCPCS,"OUTPATIENT ",,,32.16,,,21.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",28.94,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",27.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8.61,30.55,
"94761 PULSE OXIMETRY MULTIPLE CHARGE",2694761,CDM,460,RC,A4344,HCPCS,"OUTPATIENT ",,,34.52,,,23.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",31.07,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",32.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",29.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9.24,32.79,
"95115 Allergy Injection Single POC",600086,CDM,761,RC,A4344,HCPCS,"OUTPATIENT ",,,111,,,74.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",99.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",105.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",94.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.71,105.45,
"95117 Allergy Injection Multi POC",695117,CDM,940,RC,A4344,HCPCS,"OUTPATIENT ",,,51,,,34.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",45.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",48.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",43.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.65,48.45,
"95805 MSLT STUDY Charge",4995805,CDM,410,RC,A4344,HCPCS,"OUTPATIENT ",,,3789.5,,,2538.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1061.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1014.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1061.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3410.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1071.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1014.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1061.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3600.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3221.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1061.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2273.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1034.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1014.45,3600.03,
"95806 Home Sleep Study Charge",4995806,CDM,410,RC,A4344,HCPCS,"OUTPATIENT ",,,620.62,,,415.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",166.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",558.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",166.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",173.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",589.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",527.53,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",372.37,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",169.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",166.14,589.59,
"95810 INITIAL SLEEP STUDY CHARGE",4995810,CDM,410,RC,V2632,HCPCS,"OUTPATIENT ",,,5672.08,,,3800.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1588.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1518.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1588.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5104.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1604.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1518.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1588.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5388.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4821.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1588.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3403.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1549.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1518.42,5388.48,
"95811 C-PAP STUDY Charge",4995811,CDM,410,RC,V2632,HCPCS,"OUTPATIENT ",,,2323.75,,,1556.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",650.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",622.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",650.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2091.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",657.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",622.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",650.65,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2207.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1975.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",650.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1394.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",634.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",622.07,2207.56,
"95940 Continuous intraop neurophysiology monitoring, each 15 minutes",694950,CDM,360,RC,V2632,HCPCS,"OUTPATIENT ",,,400,,,268,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",360,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.08,380,
"96125 OT COGNITIVE PERFORMANCE TESTING PER HR CHARGE",4414125,CDM,430,RC,V2632,HCPCS,"OUTPATIENT ",,,95,,,63.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",90.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.43,90.25,
"96360 - ED Hydration, first hour",296360,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,969,,,649.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",259.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",872.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",274.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",259.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",271.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",920.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",823.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",581.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",264.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",259.4,920.55,
"96360 - IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR",1396360,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,969,,,649.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",259.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",872.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",274.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",259.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",271.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",920.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",823.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",581.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",264.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",259.4,920.55,
"96360 HYDRATION INFUSION >30 TO 90 MINS Charge",696360,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,969,,,649.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",259.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",872.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",274.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",259.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",271.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",920.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",823.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",581.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",264.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",259.4,920.55,
"96360 HYDRATION INFUSION INTIAL HR Charge",INF96360,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,969,,,649.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",259.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",872.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",274.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",259.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",271.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",920.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",823.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",581.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",264.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",259.4,920.55,
"96360 IV Hydration Int 31 to 90 Min Charge",4096360,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,969,,,649.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",259.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",872.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",274.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",259.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",271.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",920.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",823.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",271.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",581.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",264.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",259.4,920.55,
"96361 - IV INFUSION HYDRATION EACH ADDITIONAL HOUR",1396361,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,376.47,,,252.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",338.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",100.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",105.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",357.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",320,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",225.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",102.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.78,357.65,
"96361- ED Hydration, each additional hour",296361,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,376.47,,,252.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",338.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",100.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",105.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",357.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",320,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",225.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",102.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.78,357.65,
"96361 HYDRATION/IV FLUID EACH ADDL HOUR CHARGE",INF96361,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,376.47,,,252.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",338.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",100.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",105.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",357.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",320,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",225.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",102.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.78,357.65,
"96361 IV INFUSION EACH ADD HOUR CHARGE",4096361,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,376.47,,,252.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",338.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",100.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",105.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",357.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",320,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",225.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",102.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.78,357.65,
"96361 IV INFUSION HYDRATION ADDTL HR CHARGE",696361,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,376.47,,,252.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",338.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",100.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",105.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",357.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",320,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",105.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",225.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",102.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.78,357.65,
"96365- ED IV tx, first hour",296365,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,1060.87,,,710.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",954.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",297.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.99,1007.83,
"96365 IN INFUSION INTIAL UP TO 1HR CHARGE",1396365,CDM,260,RC,C9359,HCPCS,"OUTPATIENT ",,,1060.87,,,710.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",954.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",297.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.99,1007.83,
"96365 IV HYDRATION TH/DX INITIAL CHARGE",INF96365,CDM,260,RC,C1776,HCPCS,"OUTPATIENT ",,,1060.87,,,710.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",954.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",297.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.99,1007.83,
"96365 IV INFUSION 1ST HR Charge",4096365,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,1060.87,,,710.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",954.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",297.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.99,1007.83,
"96365 IV INFUSION INITIAL UP TO 1HR CHARGE",696365,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,1060.87,,,710.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",954.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",297.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",297.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.99,1007.83,
"96366 EACH ADDITIONAL HOUR CHARGE",1396366,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,452.6,,,303.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",407.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",429.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",384.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",271.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",123.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121.16,429.97,
"96366- ED IV tx, each additional hour",296366,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,452.6,,,303.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",407.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",429.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",384.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",271.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",123.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121.16,429.97,
"96366 IV INFUSION EACH ADD'L HR CHARGE",INF96366,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,452.6,,,303.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",407.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",429.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",384.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",271.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",123.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121.16,429.97,
"96366 IV INFUSION, EA ADDL HR Charge",696366,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,452.6,,,303.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",407.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",429.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",384.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",271.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",123.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121.16,429.97,
"96366 IV TX, EA ADDL HR, MIN 31 MIN CHARGE",4096366,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,452.6,,,303.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",407.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",429.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",384.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",271.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",123.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121.16,429.97,
"96367 ADD SEQUENTIAL INFUS UP TO 1HR CHARGE",1396367,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,482.56,,,323.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",434.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",135.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",458.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",410.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",129.18,458.43,
"96367 ADDTL SEQUENTIAL INFUSION CHARGE",INF96367,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,482.56,,,323.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",434.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",135.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",458.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",410.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",129.18,458.43,
"96367- ED IV tx, sequential infusion",296367,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,482.56,,,323.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",434.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",135.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",458.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",410.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",129.18,458.43,
"96367 IV INF SEQUENTIAL UP TO 1 HR",696367,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,482.56,,,323.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",434.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",135.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",458.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",410.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",129.18,458.43,
"96367 IV INF SEQUENTIAL UP TO 1 HR CHARGE",4096367,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,482.56,,,323.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",434.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",135.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",458.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",410.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",135.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",129.18,458.43,
"96368- ED IV tx, concurrent infusion",296368,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,195,,,130.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",175.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",185.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",117,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.2,185.25,
"96368 INFUSION IV CONCURRENT CHARGE",INF96368,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,195,,,130.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",175.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",185.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",117,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.2,185.25,
"96368 IV INF CONCURRENT",696368,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,195,,,130.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",175.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",185.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",117,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.2,185.25,
"96368 IV INF CONCURRENT CHARGE",4096368,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,195,,,130.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",175.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",185.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",117,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.2,185.25,
"96368 IV INFUSION TH/PR/DX CONCURENT CHARGE",1396368,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,195,,,130.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",175.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",185.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",117,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.2,185.25,
"96372  ED Subq/IM Injection",296372,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,91.8,,,61.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",82.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",87.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",78.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",55.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.57,87.21,
"96372 IM SC Injection Each TechFee",296372,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,91.8,,,61.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",82.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",87.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",78.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",55.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.57,87.21,
"96372 INJ IM OR SUBQ",INF96372,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,91.8,,,61.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",82.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",87.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",78.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",55.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.57,87.21,
"96372 THER/PROPH/DX INJ IM/SQ CHARGE",1396372,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,91.8,,,61.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",82.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",87.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",78.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",55.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.57,87.21,
"96372 THER/PROPH/DX INJ IM/SUBQ CHARGE",696372,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,91.8,,,61.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",82.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",87.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",78.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",55.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.57,87.21,
"96372 THERAPEUTIC IM/SQ CHARGE",4096372,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,91.8,,,61.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",82.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",87.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",78.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",55.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.57,87.21,
"96372 Therapeutic Injection; subcutaneous or intramuscular - AMB Only Inj Med Admin Charge",A96372,CDM,241,RC,C1713,HCPCS,"OUTPATIENT ",,,102,,,68.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",91.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",96.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",86.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",61.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.31,96.9,
"96374- ED Injection, single/initial",296374,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,323.55,,,216.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",86.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",291.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",86.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",90.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",307.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",275.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",194.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",88.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",86.61,307.37,
"96374 INJ IV PUSH INITIAL",4096374,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,323.55,,,216.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",86.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",291.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",86.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",90.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",307.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",275.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",194.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",88.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",86.61,307.37,
"96374 INJ IV PUSH INITIAL CHARGE",INF96374,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,323.55,,,216.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",86.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",291.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",86.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",90.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",307.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",275.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",194.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",88.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",86.61,307.37,
"96374 Inj IV Push Initial Drug Charge",696374,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,323.55,,,216.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",86.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",291.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",86.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",90.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",307.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",275.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",194.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",88.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",86.61,307.37,
"96374 inj IV push, single or initial - AMB Only Inj Med Admin Charge",4096374,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,323.55,,,216.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",86.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",291.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",86.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",90.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",307.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",275.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",194.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",88.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",86.61,307.37,
"96374 INJ/IV/DIAG OR THERA OV CHARGE",4096374,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,359.5,,,240.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",100.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",96.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",100.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",323.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",101.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",96.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",100.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",341.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",305.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",100.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",215.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",98.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",96.24,341.53,
"96374 INJ/IV/DIAG OR THERAP CHARGE",1396374,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,323.55,,,216.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",86.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",291.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",86.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",90.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",307.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",275.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",194.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",88.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",86.61,307.37,
"96375 INJ IV PUSH EA DIFFERENT DRUG",INF96375,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,204.75,,,137.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",184.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",174.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.81,194.51,
"96375 INJ IV PUSH EA DIFFERENT DRUG CHARGE",1396375,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,204.75,,,137.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",184.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",174.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.81,194.51,
"96375 IV PUSH DIFFERENT MED CHARGE",696375,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,204.75,,,137.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",184.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",174.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.81,194.51,
"96375 IV PUSH; EA ADDTL NEW DRUG/SUB CHARGE",4096375,CDM,260,RC,A6250,HCPCS,"OUTPATIENT ",,,204.75,,,137.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",184.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",174.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.81,194.51,
"96375-IV Injection, add new drug",296375,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,204.75,,,137.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",184.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",174.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.81,194.51,
"96376- ED IV Injection, add same drug",296376,CDM,260,RC,C1889,HCPCS,"OUTPATIENT ",,,45,,,30.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",40.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",42.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",38.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.05,42.75,
"96376 IV ADDITIONAL PUSH SAME DRUG CHARGE",4096376,CDM,260,RC,C9359,HCPCS,"OUTPATIENT ",,,45,,,30.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",40.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",42.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",38.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.05,42.75,
"96376 IV PUSH ADDITI SAME DRUG>30 MIN INTERVAL CHARGE",INF96376,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,45,,,30.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",40.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",42.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",38.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.05,42.75,
"96376 IV Push Addl Same Drug > 30Min Charge",696376,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,45,,,30.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",40.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",42.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",38.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.05,42.75,
"96376 IV PUSH SAME DRUG CHARGE",1396376,CDM,260,RC,V2787,HCPCS,"OUTPATIENT ",,,45,,,30.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",40.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",42.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",38.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.05,42.75,
"96377 APP ON BODY INJECTOR CHARGE",1396377,CDM,260,RC,V2632,HCPCS,"OUTPATIENT ",,,47.7,,,31.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",42.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",13.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",45.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",40.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",28.62,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.77,45.32,
"96401 CHEMO ADMIN NON HORMONAL SQ/IM  CHARGE",INF96401,CDM,331,RC,C1762,HCPCS,"OUTPATIENT ",,,83.5,,,55.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",75.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",79.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",50.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.35,79.33,
"96401 CHEMO ADMIN SQ OR IM NON-HORMONAL ANTI-N CHARGE",1396401,CDM,331,RC,V2632,HCPCS,"OUTPATIENT ",,,83.5,,,55.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",75.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",79.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",50.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.35,79.33,
"96401 CHEMOTHERAPY INJECTION IM/SQ CHARGE",4096401,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,83.5,,,55.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",75.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",79.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",50.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.35,79.33,
"96402 CHEMO ADMIN HORMONAL SQ/IM CHARGE",INF96402,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,67,,,44.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",60.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",18.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",63.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",56.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",40.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",17.94,63.65,
"96402 CHEMO HORMON ANTINEOPL SQ CHARGE",1396402,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,60.3,,,40.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",54.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",16.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57.29,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",51.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16.14,57.29,
"96409 CHEMO ADMIN IVP INITIAL CHARGE",INF96409,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,234.85,,,157.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",211.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",223.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",199.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",64.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.87,223.11,
"96409 CHEMOTHERAPY IV PUSH CHARGE",1396409,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,234.85,,,157.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",211.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",223.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",199.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",64.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.87,223.11,
"96411 - CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG",1396411,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,550.35,,,368.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",147.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",495.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",155.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",147.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",522.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",467.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",330.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",150.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",147.33,522.83,
"96411 CHEMO ADMIN IVP ADD'L CHARGE",INF96411,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,611.5,,,409.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",171.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",163.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",171.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",550.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",172.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",163.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",171.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",580.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",519.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",171.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",366.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",167,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",163.7,580.93,
"96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG",1396413,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,1235,,,827.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",330.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1111.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",349.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",330.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",345.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1173.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1049.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",741,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",337.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",330.61,1173.25,
"96413 CHEMO ADMIN IV UP TO 1 HR CHARGE",696413,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,1235,,,827.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",330.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1111.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",349.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",330.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",345.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1173.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1049.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",741,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",337.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",330.61,1173.25,
"96413 CHEMO INFUSION UP TO 1 HOUR CHARGE",INF96413,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,1235,,,827.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",330.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1111.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",349.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",330.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",345.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1173.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1049.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",345.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",741,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",337.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",330.61,1173.25,
"96415  CHEMO ADMIN, EACH ADDL HR",696415,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,553.5,,,370.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",148.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",498.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",148.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",525.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",470.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",332.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",151.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",148.17,525.83,
"96415 - CHEMOTHERAPY ADMN IV INFUSION TQ EA HR",1396415,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,553.5,,,370.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",148.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",498.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",148.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",525.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",470.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",332.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",151.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",148.17,525.83,
"96415 CHEMO ADM IV INF, EA ADDTL HR CHARGE",INF96415,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,553.5,,,370.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",148.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",498.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",148.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",525.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",470.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",332.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",151.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",148.17,525.83,
"96416 Chemotherapy admin, IV/infusion initiation of prolonged (8+ hours)",1396416,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,1376.73,,,922.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",385.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",368.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",385.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1239.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",389.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",368.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",385.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1307.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1170.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",385.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",826.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",375.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",368.55,1307.89,
"96417 - CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR",1396417,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,400.5,,,268.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",360.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.21,380.48,
"96420 - CHEMOTX ADMN IA PUSH TQ",1396420,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,618,,,414.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",556.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",173.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",587.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",525.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.44,587.1,
"96422 - CHEMOTX ADMN IA NFS TQ UP 1 HR",1396422,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,993,,,665.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",278.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",265.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",278.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",893.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",280.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",265.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",278.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",943.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",844.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",278.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",595.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",271.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",265.83,943.35,
"96423 - CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR",1396423,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,453,,,303.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",407.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",430.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",385.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",271.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",123.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121.27,430.35,
"96425 - CHEMOTX ADMN IA NFS > 8 HR PRTBLE IMPLTBL PMP",1396425,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,1017,,,681.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",284.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",272.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",284.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",915.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",287.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",272.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",284.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",966.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",864.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",284.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",610.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",277.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",272.25,966.15,
"96440 CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS",1396440,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,4143,,,2775.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1160.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1109.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1160.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3728.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1171.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1109.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1160.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3935.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3521.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1160.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2485.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1131.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1109.08,3935.85,
"96446 CHEMO ADMIN PERITONEAL CAVITY CHARGE",1396446,CDM,331,RC,C1713,HCPCS,"OUTPATIENT ",,,1627.5,,,1090.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",455.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",435.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",455.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1464.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",460.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",435.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",455.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1546.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1383.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",455.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",976.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",444.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",435.68,1546.13,
"96450 CHEMOTX ADMN CNS REQ SPINAL PUNCTURE",1396450,CDM,335,RC,C1713,HCPCS,"OUTPATIENT ",,,1141.5,,,764.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",319.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",305.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",319.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1027.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",322.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",305.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",319.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1084.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",970.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",319.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",684.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",311.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",305.58,1084.43,
"96521 Refilling/maintenance of portable pump",1396521,CDM,280,RC,C1713,HCPCS,"OUTPATIENT ",,,756,,,506.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",211.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",202.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",211.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",680.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",213.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",202.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",211.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",718.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",642.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",211.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",453.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",206.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",202.38,718.2,
"96522 Refilling/maintenance of implantable pump or reservoir for drug delivery, systemic PENTEC",1396522,CDM,280,RC,C1713,HCPCS,"OUTPATIENT ",,,630,,,422.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",168.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",567,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",168.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",176.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",598.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",535.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",176.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",378,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",168.65,598.5,
"96523 IRRIG VENOUS ACC DEVICE CHARGE",INF96523,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,222.5,,,149.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",200.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",62.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",211.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",189.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",133.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",60.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59.56,211.38,
"96523 IRRIGATION VASCULAR DEVICE CHARGE",4096523,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,222.5,,,149.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",200.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",62.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",211.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",189.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",133.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",60.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59.56,211.38,
"96523 PORT FLUSH CHARGE",696523,CDM,761,RC,C1713,HCPCS,"OUTPATIENT ",,,222.5,,,149.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",200.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",62.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",211.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",189.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",133.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",60.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59.56,211.38,
"96542 CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT",1396542,CDM,280,RC,C1713,HCPCS,"OUTPATIENT ",,,727.5,,,487.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",203.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",194.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",203.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",654.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",205.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",194.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",203.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",691.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",618.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",203.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",436.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",198.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",194.75,691.13,
"97110 PT CONTINUOUS PASSIVE MOTION (15 MIN) CHARGE",46019059,CDM,420,RC,C1713,HCPCS,"OUTPATIENT ",,,125.5,,,84.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.6,119.23,
"97140 PT - MANUAL THERAPY 15M",4601338,CDM,420,RC,C1713,HCPCS,"OUTPATIENT ",,,144,,,96.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",129.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",136.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",122.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",86.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.55,136.8,
"97597 ED DEBRIDEMENT OPEN WOUND 20 SQ CM/ OR GREATER TechFee",297597,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,182,,,121.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",163.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",154.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",109.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.72,172.9,
"97602 Remove devitalized tissue from wound, non-selective debridement, w/o anesthesia, per session",CL97602,CDM,361,RC,C1713,HCPCS,"OUTPATIENT ",,,121,,,81.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",108.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",33.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",114.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",102.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.39,114.95,
"97605 NEG PRESSURE WOUND THERAPY < 50 CM CHARGE",4097605,CDM,947,RC,C1713,HCPCS,"OUTPATIENT ",,,162.29,,,108.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",146.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",45.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",154.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",137.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",97.37,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.45,154.18,
"97606 NEG PRESSURE WOUND THERAPY > 50 CM CHARGE",4097606,CDM,947,RC,C1713,HCPCS,"OUTPATIENT ",,,506.22,,,339.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",141.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",135.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",141.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",455.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",135.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",141.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",480.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",430.29,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",141.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",303.73,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",138.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",135.52,480.91,
"97802 Dietary Consult CHARGE",9900002,CDM,949,RC,C1713,HCPCS,"OUTPATIENT ",,,70.5,,,47.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.87,66.98,
"98015 TELEPHONE EVAL, ESTABLISHED PATIENT, 40 MIN",CL98015,CDM,519,RC,C1713,HCPCS,"OUTPATIENT ",,,359,,,240.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",100.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",96.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",100.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",323.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",101.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",96.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",100.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",341.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",305.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",100.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",215.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",98.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",96.1,341.05,
"99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS",299151,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,175,,,117.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",157.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",46.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",166.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",148.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",105,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",47.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.85,166.25,
"99152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS",299152,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,184.5,,,123.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",49.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",166.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",49.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",51.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",175.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",156.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",110.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",50.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",49.39,175.28,
"99152 Moderate sedation > 5 years old, initial 15 minutes",699152,CDM,370,RC,C1713,HCPCS,"OUTPATIENT ",,,166.05,,,111.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",149.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",46.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",157.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",141.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",99.63,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.45,157.75,
"99153 MOD SED SAME PHYS/QHP EACH ADDL 15 MINS",299153,CDM,450,RC,C1713,HCPCS,"OUTPATIENT ",,,88.8,,,59.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",79.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.77,84.36,
"99153 Moderate sedation each additional 15 minutes",699153,CDM,370,RC,C1713,HCPCS,"OUTPATIENT ",,,88.8,,,59.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",79.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.77,84.36,
"99155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS TechFee",1299155,CDM,370,RC,C1713,HCPCS,"OUTPATIENT ",,,787.93,,,527.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",220.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",210.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",220.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",709.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",222.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",210.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",220.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",748.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",669.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",220.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",472.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",215.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",210.93,748.53,
"99156 MOD SED OTH PHYS/QHP 5/>YRS TechFee",299156,CDM,450,RC,C1763,HCPCS,"OUTPATIENT ",,,259,,,173.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",233.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",69.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",72.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",246.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",220.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",155.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",70.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",69.33,246.05,
"99156 Moderate sedation; initial 15 minutes",1299156,CDM,370,RC,C1713,HCPCS,"OUTPATIENT ",,,259,,,173.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",233.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",69.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",72.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",246.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",220.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",155.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",70.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",69.33,246.05,
"99157 MOD SED OTHER PHYS/QHP EA TechFee",299157,CDM,450,RC,P9016,HCPCS,"OUTPATIENT ",,,199,,,133.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",55.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",55.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",179.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",55.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",189.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",169.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",55.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",119.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.27,189.05,
"99157 Moderate sedation each additional 15 minutes",1299157,CDM,370,RC,P9040,HCPCS,"OUTPATIENT ",,,199,,,133.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",55.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",55.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",179.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",55.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",189.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",169.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",55.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",119.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.27,189.05,
"99195 Therapeutic Phlebotomy",1399195,CDM,280,RC,P9040,HCPCS,"OUTPATIENT ",,,626.56,,,419.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",175.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",167.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",175.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",563.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",167.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",175.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",595.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",532.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",175.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",375.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",171.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",167.73,595.23,
"99203 Office/Outpatient Visit - New Patient, Level 3 (30-44 min)",CL99203,CDM,519,RC,P9017,HCPCS,"OUTPATIENT ",,,321,,,215.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",89.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",89.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",288.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",85.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",89.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",304.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",272.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",89.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",192.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",87.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",85.93,304.95,
"99204 Office/Outpatient Visit - New Patient, Level 4 (45-59 min)",CL99204,CDM,519,RC,P9017,HCPCS,"OUTPATIENT ",,,481,,,322.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",432.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",408.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",128.76,456.95,
"99212 Office/Outpatient Visit - Established Patient, Level 2",CL99212,CDM,519,RC,P9017,HCPCS,"OUTPATIENT ",,,161,,,107.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",144.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",45.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",152.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",136.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.1,152.95,
"99213 Office/Outpatient Visit - Established Patient, Level 3",CL99213,CDM,519,RC,P9037,HCPCS,"OUTPATIENT ",,,260,,,174.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",234,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",69.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",72.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",221,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",71.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",69.6,247,
"99214 Office/Outpatient Visit - Established Patient, Level 4",CL99214,CDM,519,RC,P9037,HCPCS,"OUTPATIENT ",,,367,,,245.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",98.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",330.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",103.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",98.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",102.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",348.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",311.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",102.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",220.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",100.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",98.25,348.65,
"99215 Office/Outpatient Visit - Established Patient, Level 5 (40-54 min).",CL99215,CDM,519,RC,P9035,HCPCS,"OUTPATIENT ",,,519,,,347.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",145.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",145.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",467.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",146.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",145.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",493.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",441.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",145.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",311.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",141.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.94,493.05,
"99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC",299281,CDM,450,RC,P9035,HCPCS,"OUTPATIENT ",,,350,,,234.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",93.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",315,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",98.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",93.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",332.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",297.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",210,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",95.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",93.7,332.5,
"99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC",299282,CDM,450,RC,P9035,HCPCS,"OUTPATIENT ",,,425,,,284.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",382.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",403.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",361.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.77,403.75,
"99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC",299283,CDM,450,RC,P9035,HCPCS,"OUTPATIENT ",,,562,,,376.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",157.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",150.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",157.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",505.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",158.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",150.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",157.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",533.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",477.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",157.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",337.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",153.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",150.45,533.9,
"99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC",299284,CDM,450,RC,P9035,HCPCS,"OUTPATIENT ",,,1768,,,1184.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",473.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1591.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",499.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",473.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",495.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1679.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1502.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1060.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",482.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",473.29,1679.6,
"99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC",299285,CDM,450,RC,P9037,HCPCS,"OUTPATIENT ",,,2600,,,1742,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",728,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",728,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2340,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",735.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",696.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",728,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2470,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2210,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",728,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1560,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",710.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",696.02,2470,
"99291   Facility Level Critical Care Ill/Injured Patient Init 30 to 74 Min",299291,CDM,450,RC,P9037,HCPCS,"OUTPATIENT ",,,4983.68,,,3339.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1395.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1334.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1395.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4485.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1409.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1334.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1395.43,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4734.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4236.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1395.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2990.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1361.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1334.13,4734.5,
"99407 SMOKING CESSATION COUNSELING >10 MIN CHARGE",2699407,CDM,942,RC,P9037,HCPCS,"OUTPATIENT ",,,63,,,42.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",56.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",59.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",53.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16.87,59.85,
"99441 Telephone Visit   Established Patient  5-10 Min",CL99441,CDM,519,RC,P9035,HCPCS,"OUTPATIENT ",,,107,,,71.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",96.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",28.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",29.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",101.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",90.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",64.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",29.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",28.64,101.65,
"99441 Telephone Visit - Established Patient; 5-10 Min",CL99441,CDM,519,RC,P9035,HCPCS,"OUTPATIENT ",,,107,,,71.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",96.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",28.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",29.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",101.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",90.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",64.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",29.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",28.64,101.65,
"9cm Disposable Yellow Guedel Airway / 90MM AIRWAY",680193,CDM,270,RC,P9035,HCPCS,"OUTPATIENT ",,,1.47,,,0.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",0.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.39,1.4,
"A-1-Antitrypsin LC",2282103,CDM,301,RC,P9012,HCPCS,"OUTPATIENT ",,,203.53,,,136.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",183.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.99,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",193.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",173,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.48,193.35,
"ABDOMINAL BINDER 2XL",690287,CDM,271,RC,P9040,HCPCS,"OUTPATIENT ",,,59.25,,,39.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",53.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",16.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",56.29,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",50.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",35.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",15.86,56.29,
"ABDOMINAL BINDER L/XL",690030,CDM,271,RC,P9040,HCPCS,"OUTPATIENT ",,,48.21,,,32.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",43.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",13.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",45.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",40.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",28.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.91,45.8,
"ABDOMINAL BINDER UNIVERSAL",5019629,CDM,270,RC,P9040,HCPCS,"OUTPATIENT ",,,14.04,,,9.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.76,13.34,
"ABG Puncture",2613660,CDM,410,RC,P9016,HCPCS,"OUTPATIENT ",,,405.26,,,271.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",108.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",364.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",108.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",113.47,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",385,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",344.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges",243.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",108.49,385,
"Ablation Radiofrequency Sacroiliac Joint",664625,CDM,360,RC,P9016,HCPCS,"OUTPATIENT ",,,1920,,,1286.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",537.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",513.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",537.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1728,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",542.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",513.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",537.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1824,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1632,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",537.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1152,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",524.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",513.98,1824,
"ABO Grouping LC",22006056,CDM,305,RC,P9016,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.53,115.43,
ABO/Rh,2286900,CDM,302,RC,P9040,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.53,115.43,
"ABO/Rh Echo",2286900,CDM,302,RC,P9040,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.53,115.43,
"ABSC Echo",2286850,CDM,302,RC,P9040,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.39,47.5,
"ACCELL EVO3 PUTTY 2.5CC",690672,CDM,272,RC,P9016,HCPCS,"OUTPATIENT ",,,2396.16,,,1605.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",670.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",641.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",670.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2156.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",677.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",641.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",670.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2276.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2036.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",670.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1437.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",654.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",641.45,2276.35,
"ACCELL EVO3c PUTTY 2.5CC",690395,CDM,278,RC,P9016,HCPCS,"OUTPATIENT ",,,2734.08,,,1831.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",765.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",731.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",765.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1367.04,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2460.67,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",773.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",731.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",765.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2597.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2323.97,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",765.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1640.45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",746.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",731.91,2597.38,
"Acetaminophen Level",2282003,CDM,301,RC,P9016,HCPCS,"OUTPATIENT ",,,84,,,56.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",75.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",79.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",71.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",50.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.49,79.8,
"Achilles Tendon >160mm without Bone Block",690953,CDM,278,RC,P9035,HCPCS,"OUTPATIENT ",,,7768.28,,,5204.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2175.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2079.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2175.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3884.14,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6991.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2196.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2079.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2175.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7379.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6603.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2175.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4660.97,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2121.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2079.57,7379.87,
"ACHILLES TENDON BONE BLOCK",690436,CDM,278,RC,P9035,HCPCS,"OUTPATIENT ",,,7768.28,,,5204.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2175.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2079.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2175.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3884.14,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6991.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2196.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2079.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2175.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7379.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6603.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2175.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4660.97,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2121.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2079.57,7379.87,
"AChR Binding Abs LC",2223519,CDM,301,RC,P9035,HCPCS,"OUTPATIENT ",,,713,,,477.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",641.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",201.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",199.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",677.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",606.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",427.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",194.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.87,677.35,
"AChR Binding Abs, Serum LC",2223519,CDM,301,RC,P9035,HCPCS,"OUTPATIENT ",,,713,,,477.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",641.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",201.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",199.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",677.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",606.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",427.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",194.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.87,677.35,
"AChR Blocking Abs LC",2253519,CDM,301,RC,P9035,HCPCS,"OUTPATIENT ",,,713,,,477.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",641.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",201.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",199.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",677.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",606.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",427.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",194.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.87,677.35,
"AChR Modulating Ab: LC",2243519,CDM,301,RC,P9035,HCPCS,"OUTPATIENT ",,,713,,,477.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",641.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",201.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",199.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",677.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",606.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",427.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",194.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.87,677.35,
"Acid Fast Culture LC",2287116,CDM,306,RC,P9035,HCPCS,"OUTPATIENT ",,,239,,,160.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",215.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",63.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",66.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",227.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",203.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",143.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",65.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.98,227.05,
"Acid Fast Smear LC",2287208,CDM,306,RC,A9581,HCPCS,"OUTPATIENT ",,,72,,,48.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",64.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",68.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",61.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.27,68.4,
"Acid Fast Smear+Culture LC",2287116,CDM,306,RC,A9585,HCPCS,"OUTPATIENT ",,,239,,,160.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",215.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",63.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",66.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",227.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",203.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",143.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",65.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.98,227.05,
"ACL GRAFT KNIFE",690349,CDM,272,RC,J2785,HCPCS,"OUTPATIENT ",,,6345,,,4251.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1776.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.81,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1776.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5710.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",63.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1794.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.81,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",1776.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6027.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",5393.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1776.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3807,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.81,6027.75,
"ACTH, Plasma LC",2282024,CDM,301,RC,A9598,HCPCS,"OUTPATIENT ",,,145.44,,,97.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",130.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.17,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",123.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.93,138.17,
"Actin (Smooth Muscle) Antibody LC",2283516,CDM,301,RC,A9597,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",128.5,456,
"ACUMED .054 K-Wire",690752,CDM,272,RC,Q4128,HCPCS,"OUTPATIENT ",,,159,,,106.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",143.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",151.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",135.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",95.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.56,151.05,
"Acumed .054? Guide Wire",663572,CDM,272,RC,Q4137,HCPCS,"OUTPATIENT ",,,159,,,106.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",143.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",151.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",135.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",95.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.56,151.05,
"Acumed .062 x 6 Guide Wire",663791,CDM,272,RC,Q4137,HCPCS,"OUTPATIENT ",,,159,,,106.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",143.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",151.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",135.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",95.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.56,151.05,
"Acumed 1.5mm Hex Driver Tip",663255,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,705,,,472.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",188.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",634.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",188.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",669.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",599.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",423,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",188.73,669.75,
"Acumed 1.5mm Solid Hex Driver Tip with a Quick-Release connection",691600,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,549,,,367.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",153.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",146.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",153.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",494.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",155.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",146.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",153.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",521.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",466.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",153.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",329.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",149.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",146.97,521.55,
"Acumed 2.0 mm Quick Release Drill",664366,CDM,272,RC,J7042,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.19,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",1.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",1.18,376.2,
"Acumed 2.0 mm x 9 ST Guide Wire",690957,CDM,272,RC,J7120,HCPCS,"OUTPATIENT ",,,159,,,106.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",143.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.15,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",44.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",151.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",2.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",135.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",95.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.41,151.05,
"Acumed 2.3 mm Quick Release Drill",690947,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,489,,,327.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",440.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",464.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",415.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",293.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",130.91,464.55,
"Acumed 2.8 mm Quick Release Drill",663253,CDM,272,RC,G0283,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.01,376.2,
"Acumed 3.5 mm x 24 mm Locking Hexalobe Screw",690485,CDM,278,RC,C1726,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"Acumed 3.5 mm x 5 Quick Release Drill",690948,CDM,272,RC,C1768,HCPCS,"OUTPATIENT ",,,393,,,263.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",105.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",353.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",105.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",373.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",334.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",235.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",107.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",105.21,373.35,
"ACUMED ATF DRILL BIT",664125,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,891,,,596.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",249.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",238.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",249.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",801.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",251.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",238.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",249.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",846.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",757.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",249.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",534.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",243.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",238.52,846.45,
"ACUMED K-WIRE 0.062",664124,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,159,,,106.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",143.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",151.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",135.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",95.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.56,151.05,
"ACUMED SINGLE TROCAR GUIDEWIRE .035 X 5.75",690171,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,159,,,106.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",143.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",151.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",135.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",95.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.56,151.05,
"ACUMED SINGLE TROCAR GUIDEWIRE .045 X 6",690170,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,159,,,106.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",143.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",151.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",135.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",95.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.56,151.05,
"Acumed T15 Stick Fit Hexalobe Driver",663586,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,933,,,625.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",261.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",249.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",261.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",839.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",249.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",261.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",886.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",793.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",261.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",559.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",254.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",249.76,886.35,
"Acumed T8 Stick Fit Hexalobe Driver",690431,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,885,,,592.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",247.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",236.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",247.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",796.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",250.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",236.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",247.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",840.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",752.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",247.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",531,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",241.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",236.91,840.75,
"Adalimumab Lvl LC",22503866,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,773.83,,,518.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",216.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",216.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",696.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",218.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",207.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",216.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",735.14,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",657.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",216.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",464.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",211.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207.15,735.14,
"ADAMTS13 Activity LC",2285397,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,270,,,180.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",243,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",75.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",256.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",229.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",162,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",72.28,256.5,
"ADAMTS13 Activity Rfx Panel LC",2285397,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,270,,,180.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",243,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",75.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",256.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",229.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",162,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",72.28,256.5,
"ADAPTIC 3 X 16 DRESSING",690516,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,5.28,,,3.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5.02,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.49,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.17,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.41,5.02,
Adenoidectomy,OR42830,CDM,360,RC,C1776,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"Adenovirus Resp LC",22168016,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16.06,57,
"ADL Training Charge",4601202,CDM,420,RC,C1776,HCPCS,"OUTPATIENT ",,,91,,,60.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",77.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.36,86.45,
"ADL Training Charges",4411202,CDM,430,RC,C1776,HCPCS,"OUTPATIENT ",,,91,,,60.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",77.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.36,86.45,
"ADSON INSULATED BIPOLAR DISPOSABLE",680112,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,105,,,70.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",94.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",28.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",29.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",99.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",89.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",28.11,99.75,
"ADULT ABG KITS",260038,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,3.39,,,2.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.91,3.22,
"ADULT AEROSOL MASK",680071,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,0.96,,,0.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",0.86,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.15,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.27,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",0.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",0.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges",0.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.26,4.15,
"Adult Aldosterone, Supine LC",2262088,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,148.32,,,99.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",133.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",41.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",140.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",126.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.71,140.9,
"ADULT CAP NASAL CANN",680100,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,31.74,,,21.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",28.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",26.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8.5,30.15,
"ADULT C-COLLAR",200024,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,746.1,,,499.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",208.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",199.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",208.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",671.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",199.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",208.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",708.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",634.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",208.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",447.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",203.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",199.73,708.8,
"ADULT C-O2 SAMPLING",680221,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,108.6,,,72.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",97.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",103.17,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",92.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",29.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.07,103.17,
"ADULT EASY CAP CO2 D",260035,CDM,270,RC,L4631,HCPCS,"OUTPATIENT ",,,12.27,,,8.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.28,11.66,
"ADULT LONG BP CUFFS",680239,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,4.14,,,2.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.11,3.93,
"AERO ECLIPSE",260040,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,16.71,,,11.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",15.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.47,15.87,
"Aerobic Bacterial Culture LC",2287070,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.04,156.28,
"Aerobic Cult Status LC",2287070,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.04,156.28,
"AEROCLIPSE MOUTHPIEC",260039,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,14.79,,,9.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.96,14.05,
"AEROSOL DPC HIGH",260048,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,1319.64,,,884.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",369.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",353.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",369.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1187.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",373.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",353.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",369.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1253.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1121.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",369.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",791.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",360.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",353.27,1253.66,
"Aerosol Treatment",2612011,CDM,410,RC,C1776,HCPCS,"OUTPATIENT ",,,203,,,136.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",182.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",192.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",172.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.34,192.85,
"AFP Value LC",22017375,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,70,,,46.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.74,66.5,
"AFP, Serum, Tumor Marker LC",2282105,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,70,,,46.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.74,66.5,
"AFP, Tumor Marker (Serial) LC",2282105,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,70,,,46.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.74,66.5,
"AGNA-1 LC",22505575A,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.01,376.2,
"AIRLIFE ADULT MASK",260021,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,169.35,,,113.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",45.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",152.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",45.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",47.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",143.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.61,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",46.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",45.33,160.88,
"AIRSEAL 12MM ACCESS OBTURATOR WITH TIP",664472,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,245.01,,,164.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",220.51,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",232.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",208.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.01,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",66.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.59,232.76,
"AIRSEAL 5MM ACCESS OBTURATOR  WITH TIP",664470,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,231,,,154.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",207.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",196.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.84,219.45,
"AIRSEAL 8MM ACCESS OBTURATOR  WITH TIP",664471,CDM,272,RC,V2632,HCPCS,"OUTPATIENT ",,,23,,,154.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",207.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",195.51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.01,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.57,218.51,
"AIRSEAL SINGLE LUMEN FILTERED TUB SET",664487,CDM,272,RC,V2632,HCPCS,"OUTPATIENT ",,,43.26,,,28.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",38.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.11,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",36.77,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.58,41.1,
"AIRSEAL TRI LUMEN FILTERED TUBE SET",664489,CDM,272,RC,V2632,HCPCS,"OUTPATIENT ",,,236.49,,,158.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",212.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",63.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",66.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",224.67,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",201.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",141.89,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",64.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.31,224.67,
"AIRWAY NASAL 28F",1212212,CDM,271,RC,V2632,HCPCS,"OUTPATIENT ",,,5.91,,,3.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.65,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5.61,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.58,5.61,
"AIRWAY NASAL 32F",1212213,CDM,271,RC,V2632,HCPCS,"OUTPATIENT ",,,4.68,,,3.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.31,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.31,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.31,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.31,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.25,4.45,
"AIRWAY NASAL 36F",1212214,CDM,271,RC,V2632,HCPCS,"OUTPATIENT ",,,4.2,,,2.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.12,3.99,
"Alanine Aminotransferase",2284460,CDM,301,RC,C1764,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16.6,58.9,
"Albumin LC",22001081,CDM,301,RC,C1764,HCPCS,"OUTPATIENT ",,,26.4,,,17.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",23.76,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.39,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.07,25.08,
"Albumin Level",2282040,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,26.4,,,17.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",23.76,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.39,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.07,25.08,
"Albumin, Body Fluid LC",2282042,CDM,301,RC,V2632,HCPCS,"OUTPATIENT ",,,58,,,38.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",52.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",16.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",55.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",49.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",15.53,55.1,
"Albumin, Random Urine LC",2282043,CDM,301,RC,C9359,HCPCS,"OUTPATIENT ",,,194.5,,,130.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",175.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",184.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",116.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.07,184.78,
"Albumin, U LC",22140097,CDM,300,RC,C9359,HCPCS,"OUTPATIENT ",,,194.5,,,130.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",175.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",184.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",116.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.07,184.78,
"Alcon Capsular Tension Ring",690946,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,194.55,,,130.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",194.55,100,,,,,0,"fee schedule","100% of total billed charges",175.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.47,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",184.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.37,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges",116.73,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.08,194.55,
"Alcon ClearCut Sideport Knife",691150,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,27.87,,,18.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",25.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.46,26.48,
"Aldolase LC",2282085,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,110.03,,,73.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",99.03,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.53,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.02,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.46,104.53,
"Aldosterone LCMS, Serum LC",2282088,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,148.32,,,99.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",133.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",41.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",140.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",126.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.71,140.9,
"Alk Phos Isoenzyme LC",2284080,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,251,,,168.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",238.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",213.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.19,238.45,
"Alkaline Phosphatase",2284075,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,70.07,,,46.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.56,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.76,66.57,
"Alkaline Phosphatase LC",2284075,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,70.07,,,46.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.56,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.76,66.57,
"Alpha 2-Macroglobulins, Qn LC",22122137,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.57,218.5,
"Alpha-1-Antitrypsin Phenotyp LC",2282104,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,130.85,,,87.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",124.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",111.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.03,124.31,
"Alpha-1-Antitrypsin, Serum LC",2282103,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,203.53,,,136.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",183.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.99,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",193.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",173,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.48,193.35,
"ALT (SGPT) LC",22001545,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16.6,58.9,
"ALT (SGPT) P5P LC",22001547,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16.6,58.9,
"ALUM LEG SPLINT",680070,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,141.66,,,94.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",37.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",127.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",37.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",39.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",134.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",120.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",38.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",37.92,134.58,
"AMB Only Inj Med Admin Charge",4096374,CDM,260,RC,C1713,HCPCS,"OUTPATIENT ",,,323.55,,,216.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",86.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",291.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",86.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",90.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",307.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",275.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",194.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",88.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",86.61,307.37,
"Ammonia Level",2282140,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,212.5,,,142.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",191.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",56.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",201.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",180.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",127.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",56.89,201.88,
"Amphiphysin Antibody LC",22505575B,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.01,376.2,
"Amylase Level",2282150,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,137,,,91.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",38.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",38.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",123.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",36.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",38.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",130.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",116.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",38.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",82.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",37.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",36.67,130.15,
"Amylase, Body Fluid LC",2272150,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,137,,,91.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",38.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",38.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",123.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",36.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",38.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",130.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",116.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",38.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",82.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",37.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",36.67,130.15,
"ANA 12 Plus Profile (RDL) LC",2286038,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,130.5,,,87.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.93,123.98,
"ANA Comprehensive Panel LC",2286038,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,130.5,,,87.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.93,123.98,
"ANA LC",2286038,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,130.5,,,87.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.93,123.98,
"ANA w/ Reflex IFA LC",2286038,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,130.5,,,87.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.93,123.98,
"ANA w/Reflex EIA LC",2286038,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,130.5,,,87.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.93,123.98,
"ANA w/Reflex if Positive LC",2286038,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,130.5,,,87.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.93,123.98,
"Anaerobe Identification Only LC",2287076,CDM,306,RC,C1713,HCPCS,"OUTPATIENT ",,,35.52,,,23.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",31.97,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",33.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9.51,33.74,
"Anaerobic Cult Status LC",2287075,CDM,306,RC,C1713,HCPCS,"OUTPATIENT ",,,345.27,,,231.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",96.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",92.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",96.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",310.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",92.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",96.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",328.01,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",293.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",96.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",207.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",94.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",92.43,328.01,
"Anaerobic Culture",2287075,CDM,306,RC,C1713,HCPCS,"OUTPATIENT ",,,345.27,,,231.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",96.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",92.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",96.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",310.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",92.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",96.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",328.01,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",293.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",96.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",207.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",94.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",92.43,328.01,
"Anatomic Pathology Report LC",2288305,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,117,,,78.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",105.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",33.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",31.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",32.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",111.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",99.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",70.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",31.32,111.15,
"ANCA by IFA (RDL) LC",22520150,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,674,,,451.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",188.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",180.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",188.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",606.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",190.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",180.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",188.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",640.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",572.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",188.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",404.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",184.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",180.43,640.3,
"ANCHOR TISSUE RETRIVIEVAL SYSTEM 10MM",690670,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,120,,,80.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",108,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",33.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",33.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",114,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",102,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.12,114,
"Androstenedione LCMS LC",2282157,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,145,,,97.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",130.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",137.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",123.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.82,137.75,
"ANES MASK SZ 6",680201,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,21.15,,,14.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",19.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.09,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.69,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5.66,20.09,
"ANES. MASK SZ 5",680200,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,21.15,,,14.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",19.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.09,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.69,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5.66,20.09,
"ANESTHESIA CIRCUIT PEDIATRIC",1212239,CDM,271,RC,C1713,HCPCS,"OUTPATIENT ",,,25.62,,,17.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",23.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.17,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",21.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.37,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.86,24.34,
"ANGIOCATH 22G",610170,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,5.01,,,3.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4.51,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.01,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.34,4.76,
"Angiotensin-Converting Enzyme LC",2282164,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,618,,,414.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",556.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",173.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",587.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",525.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.44,587.1,
"ANKLE SUPPORT UNIVERSAL",5046027,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,22.2,,,14.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",19.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",21.09,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",18.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",13.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5.94,21.09,
"Anti GAD 65 Abs LC",22500610,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,148.32,,,99.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",133.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",41.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",140.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",126.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.71,140.9,
"Anti-Adalimumab Ab LC",22503867,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,177,,,118.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",159.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",150.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.38,168.15,
"Antibody Screen Gel",2286850,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.39,47.5,
"Antibody Screen LC",2286850,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.39,47.5,
"Anticardiolip Ab IgA/G/M Qn LC",2256147,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.85,
"Anticardiolipin Ab, IgA, Qn LC",2286147,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.85,
"Anticardiolipin Ab, IgG, Qnt LC",2286147,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.85,
"Anticardiolipin Ab, IgM, Qn LC",2276147,CDM,302,RC,c1713,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.85,
"Anti-CCP Ab, IgG + IgA (RDL) LC",2286200,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,263.75,,,176.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",70.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",237.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",70.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",73.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",250.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",224.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",158.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",70.61,250.56,
"Anti-DNA DS Ab LC",2286225,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,72.48,,,48.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",65.23,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",68.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",61.61,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.49,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.4,68.86,
"Anti-DNase B Strep Antibodies LC",2286215,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,125,,,83.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",118.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.46,118.75,
"Anti-dsDNA Antibodies LC",2286225,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,72.48,,,48.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",65.23,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",68.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",61.61,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.49,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.4,68.86,
"Antiglomerular BM Ab LC",2283516,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",128.5,456,
"Antihistone Antibodies LC",2286235,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.23,213.75,
"Anti-Hu Ab LC",22505575C,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.01,376.2,
"Anti-Infliximab Antibody LC",2252397,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,177,,,118.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",159.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",150.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.38,168.15,
"Anti-Jo-1 LC",2286235,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.23,213.75,
"Anti-MPO Ab (RDL) LC",22520154,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",128.5,456,
"Anti-Mullerian Hormone (AMH) LC",2222397,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,177,,,118.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",159.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",150.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.38,168.15,
"Antimyeloperoxidase (MPO) Abs LC",2266021,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,113.68,,,76.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",102.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.43,108,
"Antineuronal nuclear Ab type 3 LC",22505575D,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.01,376.2,
"Antinuclear Antibodies Direct LC",2286038,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,130.5,,,87.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.93,123.98,
"Antinuclear Antibodies, IFA LC",2266038,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,130.5,,,87.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.93,123.98,
"Antiparietal Cell Antibody LC",2266255,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.01,376.2,
"Anti-PR-3 Ab (RDL) LC",22520155,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",128.5,456,
"Antiproteinase 3 (PR-3) Abs LC",2276021,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,113.68,,,76.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",102.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.43,108,
"Anti-Ri Ab LC",22505575E,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.01,376.2,
"Antiscleroderma-70 Abs LC",2246235,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.23,213.75,
"Anti-Sm Ab (RDL) LC",22520131,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,224.1,,,150.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",201.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.75,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",212.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",190.49,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59.99,212.9,
"Antistreptolysin O Ab LC",2286060,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,156.58,,,104.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",140.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",133.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.95,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.92,148.75,
"Antithrombin Activity LC",2285300,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,402.71,,,269.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",362.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",382.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",342.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",241.63,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.81,382.57,
"Antithrombin Antigen LC",2285301,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.53,115.43,
"Anti-Thyroid Peroxidase Ab LC",2286376,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,190,,,127.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",50.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",171,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",50.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",53.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",180.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",161.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",50.86,180.5,
"AOS 10.5mm Cannulated Entry Reamer",690589,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1629.36,,,1091.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",456.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",436.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",456.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1466.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",460.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",436.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",456.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1547.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1384.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",456.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",977.62,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",444.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",436.18,1547.89,
"AOS 2.0mm Trocar Tip Guide Wire",690581,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1002,,,671.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",268.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",901.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",283.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",268.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",951.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",851.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",601.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",268.24,951.9,
"AOS 2.5mm Calibrated Drill (Green)",690587,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,1575,,,1055.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",441,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",421.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",441,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1417.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",445.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",421.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",441,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1496.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1338.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",441,28,,,,,0,"percent of total billed charges ","28% of total billed charges",945,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",430.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",421.63,1496.25,
"AOS 3.5mm Calibrated Drill (Gold)",690586,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,1575,,,1055.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",441,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",421.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",441,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1417.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",445.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",421.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",441,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1496.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1338.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",441,28,,,,,0,"percent of total billed charges ","28% of total billed charges",945,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",430.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",421.63,1496.25,
"AOS GUIDE PIN 3.2 X 330MM",690580,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,702,,,470.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",187.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",631.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",198.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",187.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",196.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",666.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",596.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",421.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",191.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",187.93,666.9,
"Aphasia Assessment Charge",4202468,CDM,440,RC,C1781,HCPCS,"OUTPATIENT ",,,460,,,308.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",414,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.14,437,
"APL(PML-RARA) Quant LC",2281315,CDM,301,RC,C1781,HCPCS,"OUTPATIENT ",,,562.5,,,376.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",157.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",150.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",157.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",506.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",159.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",150.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",157.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",534.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",478.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",157.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",337.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",153.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",150.58,534.38,
"Apolipoprotein A-1 LC",2282172,CDM,301,RC,C1781,HCPCS,"OUTPATIENT ",,,961.67,,,644.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",269.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",257.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",269.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",865.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",271.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",257.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",269.27,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",913.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",817.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",269.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges",577,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",262.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",257.44,913.59,
"aPTT 1:1 Norm Plas LC",22500363,CDM,300,RC,C1781,HCPCS,"OUTPATIENT ",,,54.2,,,36.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",48.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.49,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",46.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.51,51.49,
"aPTT 1:1 Saline LC",22500364,CDM,300,RC,C1781,HCPCS,"OUTPATIENT ",,,54.2,,,36.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",48.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.49,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",46.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.51,51.49,
"aPTT LC",22500513,CDM,300,RC,C1781,HCPCS,"OUTPATIENT ",,,85,,,56.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",76.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",80.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",72.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.75,80.75,
"AQUACEL 3.5 x 14",680042,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,99.24,,,66.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",89.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",27.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",94.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",84.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",59.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",26.57,94.28,
"AQUACEL 4 X 10",680041,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,89.07,,,59.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",80.16,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.84,84.62,
"AQUACEL DRESSING 3.5 x 10",663225,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,83.01,,,55.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.71,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.56,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.86,
"AQUACEL DRESSING 3.5 x 12",680043,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,98.25,,,65.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",88.43,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",27.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",93.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",83.51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",58.95,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",26.3,93.34,
"AQUAMANTYS 2.3 BIPOLAR SEALER",664826,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,1068.78,,,716.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",299.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",286.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",299.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",961.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",302.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",286.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",299.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1015.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",908.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",299.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",641.27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",291.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",286.11,1015.34,
"AQUAMANTYS 6.0 Bipolar Sealer",680061,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,1068.78,,,716.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",299.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",286.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",299.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",961.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",302.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",286.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",299.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1015.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",908.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",299.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",641.27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",291.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",286.11,1015.34,
"AQUASONIC GEL 20GR",680066,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,0.8,,,0.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",0.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.15,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",0.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",0.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",0.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.21,4.15,
"ARC REF Antibody ID",2286885,CDM,302,RC,C1781,HCPCS,"OUTPATIENT ",,,133.12,,,89.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",119.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.27,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",113.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.64,126.46,
"ARC REF Antigen Type",OB86902,CDM,302,RC,C1781,HCPCS,"OUTPATIENT ",,,303,,,203.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",81.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",272.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",85.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",81.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",287.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",257.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",181.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",82.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",81.11,287.85,
"ARC REF DAT C3",2266880,CDM,302,RC,C1781,HCPCS,"OUTPATIENT ",,,127.2,,,85.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",114.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",108.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.05,120.84,
"ARC REF DAT IgG",2276880,CDM,302,RC,C1781,HCPCS,"OUTPATIENT ",,,127.2,,,85.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",114.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",108.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.05,120.84,
"ARISTA ABSORBABLE HEMOSTATIC PARTICLES",690350,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,854.1,,,572.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",239.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",228.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",239.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",768.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",241.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",228.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",239.15,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",811.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",725.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",239.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges",512.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",233.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",228.64,811.4,
"ARMBOARD ADULT",5020988,CDM,270,RC,C1781,HCPCS,"OUTPATIENT ",,,10.5,,,7.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.81,9.98,
"ARMBOARD PEDIATRIC",5016910,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,5.07,,,3.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.36,4.82,
"Arsenic LC",2282175,CDM,301,RC,Q4100,HCPCS,"OUTPATIENT ",,,155.74,,,104.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",140.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.61,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",147.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.69,147.95,
"ARTERIAL LINE KIT",664114,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,75,,,50.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",67.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",71.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",63.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.08,71.25,
"ARTHEX DX SWIVELOCK DISP KIT",663956,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1377,,,922.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",368.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1239.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",389.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",368.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",385.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1308.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1170.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",826.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",376.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",368.62,1308.15,
"ARTHREX  DISSECTOR 4.0MM",690392,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,206.73,,,138.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",186.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",55.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",196.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",175.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",124.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",56.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",55.34,196.39,
"Arthrex #2 FiberLink Suture with Closed Loop, 26 inches (Blue)",690993,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,276,,,184.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",77.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",73.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",77.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",248.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",73.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",77.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",262.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",234.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",77.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",165.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",75.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",73.89,262.2,
"ARTHREX #2 FiberLoop Suture (Blue), 20 in  w/ Tapered Needle",690823,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,250.5,,,167.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.06,237.98,
"ARTHREX #2 FiberSnare suture, 26 length with 2? closed loop (Black/White)",690835,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,525,,,351.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",140.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",472.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",148.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",140.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",498.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",446.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges",315,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",143.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",140.54,498.75,
"ARTHREX #2 FiberSnare suture, 26 length with 2? closed loop (White/Blue)",690892,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,525,,,351.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",140.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",472.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",148.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",140.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",498.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",446.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges",315,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",143.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",140.54,498.75,
"Arthrex #2 FiberWire, 38, 2 Strands (1 blue, 1 white/black)",691179,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,175.5,,,117.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",157.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",46.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",166.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",149.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",105.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",47.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.98,166.73,
"Arthrex .062 Guidewire, 12 Long",690616,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.23,213.75,
"Arthrex .062 Guidewire, 6 Long",690614,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,201,,,134.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",180.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",190.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",170.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",120.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.81,190.95,
"Arthrex .062 Guidewire, 7 Long",690615,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,201,,,134.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",180.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",190.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",170.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",120.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.81,190.95,
"ARTHREX 1.4MM K-WIRE",690454,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,246,,,164.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",221.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",209.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.85,233.7,
"Arthrex 1.6  x 235 mm Threaded Guidewire with Trocar Tip",691565,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,150,,,100.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",135,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",142.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",127.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.16,142.5,
"Arthrex 1.6 mm x 150 mm Nitinol Guidewire Double Ended",691603,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,246,,,164.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",221.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",209.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.85,233.7,
"ARTHREX 1.6MM K-WIRE",691644,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,246,,,164.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",221.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",209.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.85,233.7,
"ARTHREX 1.7MM DRILL",690384,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,801,,,536.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",720.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.43,760.95,
"ARTHREX 19.5mm X 2mm BURR straight",664349,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1752,,,1173.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",469.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1576.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",469.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",490.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1664.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1489.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1051.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",478.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",469.01,1664.4,
"ARTHREX 2 FIBER WIRE",690544,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,77.1,,,51.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",69.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",73.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",65.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.64,73.25,
"Arthrex 2.0 Cannulated Drill Bit",663568,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX 2.0 mm Drill Bit",690701,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,426,,,285.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",114.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",383.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",114.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",404.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",362.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",114.04,404.7,
"Arthrex 2.4 mm Cannulated Drill and SutureLasso SD Wire Loop",691509,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1476,,,988.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",395.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1328.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",395.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",413.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1402.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",885.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",403.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",395.13,1402.2,
"ARTHREX 2.5 Drill Bit",664276,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,426,,,285.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",114.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",383.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",114.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",404.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",362.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",114.04,404.7,
"Arthrex 2.5mm Drill Bit",690646,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,426,,,285.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",114.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",383.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",114.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",404.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",362.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",114.04,404.7,
"Arthrex 2.7 mm Cannulated Drill Bit",664204,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX 2.7 mm Drill Bit",690645,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,426,,,285.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",114.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",383.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",114.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",404.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",362.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",114.04,404.7,
"ARTHREX 2.9MM CANNULATED DRILL",690455,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex 3.0 Sterile Burr/ Drill",691356,CDM,272,RC,Q4100,HCPCS,"OUTPATIENT ",,,1251,,,838.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",350.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",334.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",350.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1125.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",353.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",334.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",350.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1188.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1063.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",350.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",750.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",341.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",334.89,1188.45,
"Arthrex 3.0mm Cannulated Drill Bit",691563,CDM,272,RC,V2632,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"ARTHREX 3.0MM DRILL BIT",690469,CDM,272,RC,V2632,HCPCS,"OUTPATIENT ",,,1476,,,988.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",395.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1328.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",395.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",413.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1402.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",885.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",403.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",395.13,1402.2,
"Arthrex 3.2 mm Cannulated Drill Bit",691568,CDM,272,RC,Q4160,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"Arthrex 3.2mm Cannulated Drill Bit AR-8750-04",691679,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"ARTHREX 3.5 PROFILE DRILL",664203,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,450,,,301.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",120.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",405,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",127.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",120.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",427.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",382.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126,28,,,,,0,"percent of total billed charges ","28% of total billed charges",270,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",120.47,427.5,
"ARTHREX 3.6MM SHAFT DRILL",690456,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex 3.9mm BioComposite Achilles SpeedBridge with JumpStart Dressing",691429,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,18636,,,12486.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5218.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4988.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5218.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16772.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5270.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4988.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5218.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17704.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15840.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5218.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11181.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5089.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4988.86,17704.2,
"ARTHREX 4.0MM SHAFT REAMER",690457,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,750,,,502.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",675,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",212.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",200.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",210,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",712.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",637.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges",450,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",204.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.78,712.5,
"Arthrex 4-0 FiberLoop Suture, 10 in (Blue) w/Tapered Needle, 17.9 mm 3/8 circle",663940,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,2102.4,,,1408.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",588.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",562.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",588.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1892.16,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",594.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",562.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",588.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1997.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1787.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",588.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1261.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",574.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",562.81,1997.28,
"Arthrex 4-0 FiberWire, 18 (blue) w/Diamond Point Needle, 18.7 mm 3/8 Circle AR-7228",663992,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,77.1,,,51.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",69.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",73.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",65.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.64,73.25,
"Arthrex 7.0 Profile Drill",691556,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1002,,,671.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",268.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",901.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",283.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",268.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",951.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",851.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",601.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",268.24,951.9,
"ARTHREX 8MM CANNULATED REAMER",690445,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1300,,,871,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",364,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",348.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",364,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1170,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",367.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",348.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",364,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1235,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1105,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",364,28,,,,,0,"percent of total billed charges ","28% of total billed charges",780,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",355.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",348.01,1235,
"Arthrex 8mm Low-Profile Reamer",691441,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex 9mm Graft Tube",691532,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,627,,,420.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",175.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",167.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",175.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",564.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",167.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",175.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",595.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",532.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",175.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",376.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",171.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",167.85,595.65,
"Arthrex ACP Kit Series I",664104,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"ARTHREX ACP KIT SERIES II",664103,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,849,,,568.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",237.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",227.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",237.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",764.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",227.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",237.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",806.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",721.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",237.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",509.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",231.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",227.28,806.55,
"ARTHREX AMNION MATRIX THIN 4CM X 4CM",690339,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,14836,,,9940.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4154.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3971.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4154.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13352.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4195.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3971.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4154.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14094.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12610.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4154.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8901.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4051.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3971.6,14094.2,
"ARTHREX ANGLED REAMER SMALL",690470,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1476,,,988.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",395.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1328.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",395.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",413.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1402.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",885.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",403.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",395.13,1402.2,
"ARTHREX ANKLE DISTRACTION STRAP",664010,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,788.4,,,528.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",220.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",211.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",220.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",709.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",222.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",211.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",220.75,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",748.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",670.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",220.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges",473.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",215.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",211.05,748.98,
"ARTHREX APEX SUTURE KIT",663305,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1200,,,804,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",321.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1080,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",339.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",321.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",336,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1140,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1020,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges",720,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",327.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",321.24,1140,
"ARTHREX APOLLO RF ABLATOR 90 XL",664565,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,665.76,,,446.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",186.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",178.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",186.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",599.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",178.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",186.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",632.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",565.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",186.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",399.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",181.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",178.22,632.47,
"ARTHREX APOLLO RF SJ50 DEGREE",690101,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1074,,,719.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",300.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",287.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",300.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",966.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",287.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",300.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1020.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",912.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",300.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",644.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",293.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",287.51,1020.3,
"Arthrex Apollo RF? i90, Aspirating Ablator 90?",690690,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,705,,,472.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",188.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",634.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",188.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",669.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",599.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",423,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",188.73,669.75,
"ARTHREX APOLLO WAND SHOULDER",663187,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,665.76,,,446.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",186.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",178.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",186.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",599.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",178.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",186.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",632.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",565.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",186.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",399.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",181.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",178.22,632.47,
"Arthrex ApolloRF MP50, Aspirating Ablator 50?, Multi-Port",663030,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,697.29,,,467.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",195.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",195.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",627.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",197.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",195.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",662.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",592.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",195.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",418.37,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.66,662.43,
"ARTHREX BANANA KNIFE",664005,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,300,,,201,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",270,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",285,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",255,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.31,285,
"Arthrex BB Tak Smooth",663155,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,250.5,,,167.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.06,237.98,
"ARTHREX BB TAK THREADED",690647,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,426,,,285.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",114.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",383.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",114.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",404.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",362.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",114.04,404.7,
"ARTHREX Bone Cutter, 5.5 mm x 13 cm",690663,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,1156.35,,,774.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",323.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",309.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",323.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1040.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",327.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",309.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",323.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1098.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",982.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",323.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",693.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",315.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",309.55,1098.53,
"Arthrex Bone Dowel Revision Kit, 10 mm",690091,CDM,272,RC,C1781,HCPCS,"OUTPATIENT ",,,2451,,,1642.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",686.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",656.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",686.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2205.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",693.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",656.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",686.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2328.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2083.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",686.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1470.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",669.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",656.13,2328.45,
"ARTHREX BURR OVAL SMALL JOINT 3.0",664443,CDM,272,RC,Q4021,HCPCS,"OUTPATIENT ",,,1156.35,,,774.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",323.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",309.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",323.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1040.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",327.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",309.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",323.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1098.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",982.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",323.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",693.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",315.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",309.55,1098.53,
"ARTHREX BURR ROUND 4.0",663340,CDM,272,RC,A4580,HCPCS,"OUTPATIENT ",,,177,,,118.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",159.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",150.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.38,168.15,
"ARTHREX BURR ROUND SJ 3.0",664048,CDM,272,RC,C1788,HCPCS,"OUTPATIENT ",,,231.27,,,154.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",208.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",196.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.91,219.71,
"Arthrex Burr, FlushCut Oval, 12 Flute, 5.0 mm x 13 cm",690942,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,330,,,221.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",297,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",313.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",280.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",88.34,313.5,
"ARTHREX Burr, Oval, 12 Flute, 5.5 mm x 13 cm",690665,CDM,272,RC,G0103,HCPCS,"OUTPATIENT ",,,1033.65,,,692.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",289.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",289.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",930.29,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.15,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,208.04,208.04,246.62,"1 through 10",other,"not separately reimbursment",292.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",289.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",981.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",878.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",289.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",620.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.15,981.97,
"Arthrex Burr, Shannon, rec. 3.0 ? 30.2 mm",691557,CDM,272,RC,C1820,HCPCS,"OUTPATIENT ",,,1752,,,1173.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",469.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1576.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",469.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",490.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1664.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1489.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1051.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",478.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",469.01,1664.4,
"Arthrex Cage Screw Sizer",690439,CDM,272,RC,Q4196,HCPCS,"OUTPATIENT ",,,690,,,462.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",193.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",184.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",193.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",621,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",195.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",184.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",193.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",655.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",586.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",193.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",414,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",188.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",184.71,655.5,
"ARTHREX CANNULA 7X7 INSTRUMENT",663465,CDM,272,RC,C1785,HCPCS,"OUTPATIENT ",,,126,,,84.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",113.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",107.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.73,119.7,
"ARTHREX CANNULA PASSPORT 8MM X 3CM",663730,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,160.5,,,107.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",144.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",152.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",136.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.97,152.48,
"ARTHREX CANNULATED DRILL 2.75MM",690607,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1752,,,1173.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",469.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1576.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",469.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",490.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1664.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1489.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1051.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",478.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",469.01,1664.4,
"ARTHREX CANNULATED DRILL 5MM",690172,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX CANNULATED DRILL 6MM",690422,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX Cannulated Headed Reamer, 9 mm",690620,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,753.36,,,504.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",210.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",201.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",210.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",678.02,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",213.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",201.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",210.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",715.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",640.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",210.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",452.02,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",205.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",201.67,715.69,
"Arthrex Compression FT Pin, solid (sterile), 1.9 mm x 30 mm",691238,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1752,,,1173.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",469.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1576.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",469.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",490.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1664.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1489.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1051.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",478.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",469.01,1664.4,
"Arthrex Disposable Drill Guide Kit, Knee FiberTak",691096,CDM,272,RC,V2632,HCPCS,"OUTPATIENT ",,,1227,,,822.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",343.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",328.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",343.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1104.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",347,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",328.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",343.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1165.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1042.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",343.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",736.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",335.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",328.47,1165.65,
"Arthrex Disposable Instruments Kit for Bio-Tenodesis Screw",663192,CDM,272,RC,C1769,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex Disposable Kit, Curved Spear for Knotless FiberTak Anchor",691344,CDM,272,RC,L8689,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex Disposable Kit, Nano SwiveLock, 2.5 x 7 mm",691094,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,1476,,,988.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",395.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1328.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",395.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",413.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1402.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",885.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",403.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",395.13,1402.2,
"ARTHREX Disposable Kit, Straight Spear for Knotless FiberTak Anchor",690845,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"ARTHREX Disposable Punch, for 4.5 mm PushLock and 4.5 mm Corkscrew FT",690555,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,375,,,251.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",105,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",105,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",337.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",100.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",105,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",356.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",318.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",105,28,,,,,0,"percent of total billed charges ","28% of total billed charges",225,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",102.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.39,356.25,
"ARTHREX Disposables Kit for 2.6 FiberTak Anchors",690743,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX Disposables Kit for 3 mm SutureTak (includes: Spear/Trocar and Drill)",663464,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,801,,,536.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",720.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.43,760.95,
"ARTHREX Disposables Kit for 3 x 8 mm Bio-Tenodesis",663596,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1476,,,988.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",395.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1328.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",395.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",413.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1402.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",885.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",403.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",395.13,1402.2,
"ARTHREX Disposables Kit, for FiberTak DX Suture Anchor, with Drill Guide, 1.6 mm GuideWire and 1.35",664151,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1377,,,922.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",368.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1239.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",389.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",368.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",385.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1308.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1170.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",826.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",376.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",368.62,1308.15,
"ARTHREX Dissector, SJ 3.0 mm x 7 cm",690617,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,46.26,,,30.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",41.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",39.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.38,43.95,
"ARTHREX DRILL BIT 1.7MM GRAD.",663329,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,292.5,,,195.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",81.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",78.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",81.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",263.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",82.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",78.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",81.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",277.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",248.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",81.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",175.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",79.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",78.3,277.88,
"ARTHREX DRILL BIT 2.5MM GRAD.",663328,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,339,,,227.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.75,322.05,
"Arthrex Drill Bit 2mm Graduated",663382,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,477,,,319.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",133.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",127.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",133.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",429.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",134.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",127.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",133.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",453.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",405.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",133.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",286.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",130.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",127.69,453.15,
"Arthrex Drill Bit 3.5mm",663385,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",106.01,376.2,
"Arthrex Drill Bit, 2.0 mm, Long",691605,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1002,,,671.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",268.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",901.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",283.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",268.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",951.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",851.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",601.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",268.24,951.9,
"Arthrex Drill Bit, 2.0 mm, Short",691604,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,801,,,536.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",720.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.43,760.95,
"Arthrex Drill Bit, 3.0mm",691405,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,576,,,385.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",154.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",518.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",162.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",154.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",161.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",547.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",489.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",345.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",157.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",154.2,547.2,
"Arthrex Drill Bit, Cannulated, 2.6 mm",690551,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"Arthrex Drill Bit, Cannulated, 5.0 mm",691555,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"ARTHREX DRILL CANNULATED 7.5MM",663220,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,837,,,560.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",753.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",224.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",234.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",795.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",711.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",502.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",228.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",224.06,795.15,
"Arthrex Drill, 5.5 mm Cannulated",691066,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex Drill, Non-Cannulated, 4 mm",690613,CDM,272,RC,A9500,HCPCS,"OUTPATIENT ",,,576,,,385.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",154.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",518.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",162.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",154.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",161.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",547.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",489.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",161.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",345.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",157.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",154.2,547.2,
"ARTHREX DUAL WAVE TUBING",690388,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1401.6,,,939.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",392.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",375.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",392.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1261.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",396.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",375.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",392.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1331.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1191.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",392.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",840.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",382.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",375.21,1331.52,
"Arthrex DynaNite FlexWire .86 mm Double-Tipped Nitinol G-wire, Two Zone",691253,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,661.2,
"ARTHREX DynaNite FlexWire 1.1 mm Double-Tipped Nitinol G-wire, Two Zone",690697,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,487.05,,,326.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",438.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",462.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",413.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",292.23,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",130.38,462.7,
"Arthrex DynaNite FlexWire 1.6 mm Double-Tipped Nitinol G-wire, Two Zone",691236,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,661.2,
"ARTHREX DYNANITE NITINOL STAPLE WITH INSTRUMENTATION 11W X 10L",690351,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9968,,,6678.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2818.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2668.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2791.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9469.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8472.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2722.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2668.43,9469.6,
"ARTHREX DynaNite Nitinol Staple with Instruments, 13 mm x 15/12 mm",690677,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12636,,,8466.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3382.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11372.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3573.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3382.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3538.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12004.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10740.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7581.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3450.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3382.66,12004.2,
"Arthrex DynaNite Nitinol Staple with Instruments, 9 mm x 10 mm",691237,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,7476,,,5008.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2093.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2001.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2093.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",6728.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2114.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2001.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2093.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7102.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6354.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2093.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4485.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2041.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2001.33,7102.2,
"ARTHREX DynaNite SuperMX Staple with Instrumentation, 15W x 15L",690678,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,16636,,,11146.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4658.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4453.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4658.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",14972.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4704.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4453.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4658.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15804.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14140.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4658.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9981.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4543.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4453.46,15804.2,
"ARTHREX EndoBlade, Gastroc Recession System",664128,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,3136.08,,,2101.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",878.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",839.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",878.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2822.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",886.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",839.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",878.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2979.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2665.67,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",878.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1881.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",856.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",839.53,2979.28,
"Arthrex FiberLink SutureTape, 1.3 mm, with Loop (White/Blue)",691141,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,426,,,285.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",114.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",383.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",114.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",404.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",362.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",255.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",114.04,404.7,
"Arthrex FiberSnare, #2 FiberWire, 26, (green), stiffened w/Closed Loop 12",691245,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,525,,,351.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",140.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",472.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",148.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",140.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",498.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",446.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges",315,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",143.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",140.54,498.75,
"Arthrex FiberTape Sternal Closure, 2 mm, 36? (White/Blue) w/ Reverse Cutting Needle",691230,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"ARTHREX FIBULOCK IMPLANT SYSTEM",690453,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,2452.8,,,1643.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",686.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",656.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",686.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2207.52,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",693.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",656.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",686.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2330.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2084.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",686.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1471.68,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",669.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",656.61,2330.16,
"ARTHREX GRAFTNET",663949,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,1326,,,888.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",354.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1193.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",374.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",354.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",371.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1259.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1127.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",795.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",354.97,1259.7,
"ARTHREX GREEN CANNULA",690207,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,126,,,84.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",113.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",107.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.73,119.7,
"ARTHREX GUIDEWIRE 1.1MM",664201,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,111,,,74.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",99.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",105.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",94.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.71,105.45,
"ARTHREX GUIDEWIRE THD 0.86MM",663569,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,111,,,74.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",99.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",105.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",94.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.71,105.45,
"Arthrex Guidewire w/ Trocar Tip, .053in",663386,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,100.5,,,67.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",90.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",95.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",85.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",60.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",26.9,95.48,
"Arthrex Guidewire with Trocar Tip .89mm",691645,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,111,,,74.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",99.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",105.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",94.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.71,105.45,
"Arthrex Guidewire with Trocar Tip, threaded, 2.4 mm ? 23.5 cm",691554,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,150,,,100.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",135,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",142.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",127.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.16,142.5,
"Arthrex Guidewire, 1.6x150mm, Capital Frag",691357,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,246,,,164.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",221.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",209.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.85,233.7,
"Arthrex HD Scorpion Suture Passer with Megaloader",690717,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX iBalance UKA Disposable Tibial Cutting Guide Right",690872,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,3000,,,2010,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2700,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",848.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",803.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",840,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2850,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2550,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",819.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",803.1,2850,
"Arthrex IntraOsseous BioPlasty Kit, Knee, Open Tip w/ Decompression Device",691089,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,4251,,,2848.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1190.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1137.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1190.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3825.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1202.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1137.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1190.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4038.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3613.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1190.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2550.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1160.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1137.99,4038.45,
"ARTHREX JumpStart, 1.5 x 8 Antimicrobial Wound Dressing",690696,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,96,,,64.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",86.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",91.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",81.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.7,91.2,
"ARTHREX JumpStart, 2 x 5 Antimicrobial Wound Dressing",690676,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,81,,,54.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",72.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",22.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",76.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",68.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",48.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",21.68,76.95,
"ARTHREX KNOT PUSHER",663348,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,537,,,359.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",150.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",143.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",150.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",483.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",143.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",150.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",510.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",456.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",150.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",322.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",146.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",143.75,510.15,
"Arthrex Knot Pusher / Suture Cutter with Portal Skid",690326,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,1101,,,737.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",308.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",294.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",308.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",990.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",311.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",294.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",308.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1045.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",935.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",308.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",660.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",300.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",294.74,1045.95,
"Arthrex Knotless BioComposite SwiveLock SP, 5.5 mm x 24.5 mm w/ #2 suture (blue), self-punching PEEK",691289,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,1646.88,,,1103.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",461.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",440.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",461.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",823.44,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1482.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",465.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",440.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",461.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1564.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1399.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",461.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",988.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",449.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",440.87,1564.54,
"Arthrex Knotless TensionTight Button Implant System",691579,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,4377,,,2932.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1225.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1171.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1225.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3939.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1237.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1171.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1225.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4158.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3720.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1225.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2626.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1195.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1171.72,4158.15,
"ARTHREX K-WIRE 1.6MM",664319,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,75,,,50.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",67.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",71.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",63.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.08,71.25,
"Arthrex K-Wire,1.35mm x 170mm",691562,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,100.5,,,67.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",90.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",95.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",85.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",60.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",26.9,95.48,
"ARTHREX K-WIRES 1.1MM",690300,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,201,,,134.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",180.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",190.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",170.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",120.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.81,190.95,
"ARTHREX LABRAL TAPE 1.5 MM",663597,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,241.5,,,161.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",67.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",64.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",67.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",217.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",68.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",64.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",67.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",229.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",205.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",67.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",144.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",65.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",64.65,229.43,
"ARTHREX LATERAL TRACTION ARM SLEEVE",690082,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,168.18,,,112.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",45.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",151.36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",45.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",47.09,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",159.77,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",142.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges",100.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",45.02,159.77,
"Arthrex Locking Tower, 2.7 mm",691606,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,1425,,,954.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",399,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",381.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",399,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1282.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",381.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",399,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1353.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1211.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",399,28,,,,,0,"percent of total billed charges ","28% of total billed charges",855,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",389.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",381.47,1353.75,
"Arthrex Low Profile Reamer 6.5 mm",690931,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex Low Profile Reamer, 10 mm",690323,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex Low Profile Reamer, 9.5 mm",691290,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"Arthrex MaxForce MTP Compression Device",691591,CDM,272,RC,A6407,HCPCS,"OUTPATIENT ",,,2475,,,1658.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",693,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",662.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",693,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2227.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",699.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",662.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",693,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2351.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2103.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",693,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1485,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",675.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",662.56,2351.25,
"ARTHREX Metatarsal Reamer, 18 mm",690702,CDM,272,RC,A6457,HCPCS,"OUTPATIENT ",,,2250,,,1507.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",630,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",602.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",630,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2025,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",636.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",602.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",630,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2137.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1912.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",630,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1350,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",614.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",602.33,2137.5,
"ARTHREX Mini SutureTak Disposable Kit",663156,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"ARTHREX MIS Irrigation Clip",690679,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1476,,,988.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",395.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1328.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",395.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",413.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1402.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",885.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",403.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",395.13,1402.2,
"ARTHREX MIS IRRIGATION TUBING SET",664350,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,163.5,,,109.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",147.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",45.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",155.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",138.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.77,155.33,
"Arthrex Mixing and Delivery System, Small Applicator",691091,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1227,,,822.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",343.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",328.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",343.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1104.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",347,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",328.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",343.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1165.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1042.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",343.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",736.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",335.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",328.47,1165.65,
"Arthrex Mixing Syringe, 14 cc with Luer Cap",691090,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,750,,,502.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",675,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",212.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",200.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",210,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",712.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",637.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges",450,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",204.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.78,712.5,
"ARTHREX MULTIFIRE SCORPION NEEDLE",663191,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,595.68,,,399.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",536.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",565.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.41,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.46,565.9,
"Arthrex NanoNeedle Scope, 125 mm",691265,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,2625,,,1758.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",735,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",702.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",735,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2362.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",742.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",702.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",735,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2493.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2231.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",735,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1575,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",716.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",702.71,2493.75,
"ARTHREX NITINOL PIN 2.8MM",690468,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2001,,,1340.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",560.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",535.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",560.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1000.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1800.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",565.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",535.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",560.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1900.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1700.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",560.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1200.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",546.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",535.67,1900.95,
"ARTHREX Orange Crystal Cannula, 5.75 mm ID x 7 cm, Distal Ring",690574,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,126,,,84.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",113.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",107.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.73,119.7,
"ARTHREX OSTEOCHONDRAL FLAP REPAIR SINGLE SHOT INSTRUMENTS",690481,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1026,,,687.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",287.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",287.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",923.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",290.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",287.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",974.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",872.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",287.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",615.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",280.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.66,974.7,
"ARTHREX PassPort Button Cannula, 10 mm ID x 3 cm",690667,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,160.5,,,107.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",144.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",152.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",136.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.97,152.48,
"Arthrex PassPort Button Cannula, 10 mm ID x 4 cm",691288,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,160.5,,,107.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",144.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",152.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",136.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.97,152.48,
"ARTHREX PassPort Button Cannula, 10 mm ID x 5 cm",690554,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,160.5,,,107.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",144.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",152.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",136.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.97,152.48,
"ARTHREX PassPort Button Cannula, 8 mm ID x 5 cm",690664,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,160.5,,,107.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",144.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",152.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",136.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",42.97,152.48,
"ARTHREX Percutaneous Insertion Kit for 3 mm Knotless SutureTak Anchor",690622,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1776,,,1189.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",497.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",475.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",497.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1598.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",502.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",475.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",497.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1687.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",497.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1065.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",485.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",475.44,1687.2,
"ARTHREX Phalangeal Reamer, 18 mm",690708,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,2250,,,1507.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",630,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",602.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",630,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2025,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",636.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",602.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",630,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2137.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1912.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",630,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1350,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",614.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",602.33,2137.5,
"ARTHREX POWER RASP",664480,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,508.08,,,340.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",142.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",136.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",142.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",457.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",136.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",142.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",482.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",431.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",142.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",304.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",138.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",136.01,482.68,
"ARTHREX POWER RASP 5.5",663193,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,508.08,,,340.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",142.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",136.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",142.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",457.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",136.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",142.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",482.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",431.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",142.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",304.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",138.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",136.01,482.68,
"ARTHREX POWERPICK 45 DEGREE",664704,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,507,,,339.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",135.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",456.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",135.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",141.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",481.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",430.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",304.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",138.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",135.72,481.65,
"Arthrex PowerPick Instrument, 30?, 1.5 mm, 13 cm",691177,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,507,,,339.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",135.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",456.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",135.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",141.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",481.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",430.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",304.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",138.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",135.72,481.65,
"Arthrex Profile Drill, for 5.0 Large Compression FT Screws",691680,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1002,,,671.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",268.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",901.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",283.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",268.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",951.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",851.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",601.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",268.24,951.9,
"Arthrex Punch, Disposable, for 5.5 mm Corkscrew FT and 4.75 and 5.5 mm SwiveLock Anchor",663301,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,375,,,251.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",105,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",105,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",337.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",100.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",105,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",356.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",318.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",105,28,,,,,0,"percent of total billed charges ","28% of total billed charges",225,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",102.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.39,356.25,
"ARTHREX PURPLE TWIST IN CANNULA",690208,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,126,,,84.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",113.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",107.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.73,119.7,
"ARTHREX PUSHLOK DRILL GUIDE 3.5",690077,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,876,,,586.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",788.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",234.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",245.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",832.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",744.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",245.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",525.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",239.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",234.51,832.2,
"ARTHREX Quick Connect Driver (For 20 mm and 30 mm Screws)",690621,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1752,,,1173.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",469.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1576.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",469.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",490.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1664.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1489.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",490.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1051.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",478.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",469.01,1664.4,
"ARTHREX REAMER LO PROFILE 6MM",690541,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX REAMER LO PROFILE 7.5MM",690521,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX REAMER LO PROFILE 7MM",663630,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,975,,,653.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",261.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",877.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",261.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",273,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",926.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",828.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",273,28,,,,,0,"percent of total billed charges ","28% of total billed charges",585,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",266.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",261.01,926.25,
"ARTHREX Reamer, long, cannulated, sterile, 3.2 mm",690549,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,750,,,502.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",675,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",212.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",200.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",210,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",712.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",637.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",210,28,,,,,0,"percent of total billed charges ","28% of total billed charges",450,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",204.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.78,712.5,
"ARTHREX Reverse Cutting Needle with Nitinol Loop, C-13, 1/2 Circle, 36.6 mm long",664355,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,96,,,64.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",86.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",91.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",81.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.7,91.2,
"ARTHREX SABRE SJ 2MM",663567,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,231.27,,,154.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",208.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",196.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.91,219.71,
"ARTHREX SABRE TOOTH BLADE CURVED 4.0",662704,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,231.27,,,154.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",208.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",196.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.91,219.71,
"ARTHREX SCREW BIOCOMPOSITE INTERFERENCE TAPERED TIP",690072,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,1568,,,1050.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",439.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",419.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",439.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",784,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1411.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",443.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",419.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",439.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1489.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1332.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",439.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",940.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",428.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",419.75,1489.6,
"ARTHREX SHAVER BLADE 3.8MM END CUTTER",663029,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,177,,,118.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",159.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",150.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.38,168.15,
"ARTHREX SHAVER BLADE 5.5 EXCALIBUR",69009,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,206.73,,,138.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",186.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",55.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",196.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",175.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",124.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",56.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",55.34,196.39,
"ARTHREX SHAVER BURR 5.5 OVAL FLUSHCUT",645267,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,231.27,,,154.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",208.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",196.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.91,219.71,
"ARTHREX SHAVER EXCALIBER 4.0 STRAIGHT",663642,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,206.73,,,138.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",186.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",55.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",196.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",175.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",124.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",56.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",55.34,196.39,
"ARTHREX SHAVER EXCALIBER 5.0",663339,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,885,,,592.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",247.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",236.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",247.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",796.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",250.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",236.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",247.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",840.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",752.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",247.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",531,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",241.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",236.91,840.75,
"ARTHREX SHAVER SABRE SJ 3.0",664047,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,231.27,,,154.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",208.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",196.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.91,219.71,
"ARTHREX SHAVER TORPEDO 4.0",663341,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,507,,,339.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",135.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",456.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",135.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",141.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",481.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",430.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",141.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",304.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",138.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",135.72,481.65,
"ARTHREX Short 2.9 mm BioComposite PushLock Implant System",690737,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,4700,,,3149,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1316,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1258.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1316,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4230,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1329.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1258.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1316,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4465,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3995,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1316,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2820,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1283.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1258.19,4465,
"Arthrex Slotted Impaction Device",691573,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,3201,,,2144.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",896.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",856.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",896.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2880.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",905.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",856.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",896.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3040.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2720.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",896.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1920.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",874.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",856.91,3040.95,
"ARTHREX STIMUBLAST PUTTY 2.5CC",663238,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1760,,,1179.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",492.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",471.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",492.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",880,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1584,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",497.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",471.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",492.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1672,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1496,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",492.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1056,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",480.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",471.15,1672,
"Arthrex Suction Cobb",690558,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,501,,,335.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",140.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",134.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",140.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",450.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",141.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",134.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",140.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",475.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",425.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",140.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",300.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",136.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",134.12,475.95,
"Arthrex Suture #2 FiberLoop Suture, 20 (Blue) w/Straight Needle AR-7234",663342,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,175.2,,,117.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",157.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",46.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",166.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",148.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",105.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",47.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.9,166.44,
"Arthrex Suture 2-0 FiberWire Suture, 18 in (Blue) w/Tapered Needle, 17.9 mm 3/8 circle AR-7220",664442,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,77.1,,,51.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",69.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",73.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",65.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.64,73.25,
"ARTHREX SUTURE TAK KIT SM JNT",663517,CDM,272,RC,C1768,HCPCS,"OUTPATIENT ",,,501,,,335.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",140.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",134.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",140.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",450.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",141.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",134.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",140.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",475.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",425.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",140.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",300.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",136.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",134.12,475.95,
"Arthrex Suture Tensioner/Cutter for 2-0 and 0 FiberWire Suture",664137,CDM,272,RC,C1768,HCPCS,"OUTPATIENT ",,,613.2,,,410.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",171.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",164.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",171.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",551.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",173.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",164.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",171.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",582.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",521.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",171.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",367.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",167.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",164.15,582.54,
"Arthrex SutureLasso SD 25?, Tight Curve Right",690779,CDM,272,RC,C1763,HCPCS,"OUTPATIENT ",,,702,,,470.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",187.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",631.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",198.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",187.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",196.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",666.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",596.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",421.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",191.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",187.93,666.9,
"Arthrex SutureLasso SD 45?, Curve Right",690781,CDM,272,RC,C1763,HCPCS,"OUTPATIENT ",,,702,,,470.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",187.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",631.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",198.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",187.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",196.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",666.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",596.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",196.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",421.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",191.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",187.93,666.9,
"Arthrex SutureLasso SD 90?",663462,CDM,272,RC,C9359,HCPCS,"OUTPATIENT ",,,490.56,,,328.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",137.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",131.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",137.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",441.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",131.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",137.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",466.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",416.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",137.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",294.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",131.32,466.03,
"Arthrex SutureLoc, Meniscal Root Repair Kit",691507,CDM,272,RC,C9359,HCPCS,"OUTPATIENT ",,,10002,,,6701.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9001.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9501.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8501.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6001.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677.54,9501.9,
"Arthrex SutureTape 1.3 mm, 40 in (White/Blue), With Tapered Ends and Tapered Needle, 26.5 mm 1/2 Cir",663849,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,122.64,,,82.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",110.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",116.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",104.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.83,116.51,
"Arthrex SutureTape, 1.3 mm, 40 in (Black/White) w/ Tapered Needle",691227,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,250.5,,,167.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.06,237.98,
"Arthrex SutureTape, x-pattern, 1.3 mm, two each 40 in Strands (1 White/Blue, 1 White/Black) AR-7501",664340,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,227.76,,,152.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",204.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",64.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",63.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",216.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",193.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",136.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.97,216.37,
"Arthrex SutureTape, x-pattern, 1.3mm",691661,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,525,,,351.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",140.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",472.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",148.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",140.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",498.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",446.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges",315,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",143.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",140.54,498.75,
"ARTHREX SYNDESMOSIS DRILL 2.5MM",690452,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,332.88,,,223.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",93.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",89.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",93.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",299.59,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",94.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",89.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",93.21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",316.24,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",282.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",93.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",199.73,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",89.11,316.24,
"Arthrex T3 AMZ Disposables Kit",691678,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,2496,,,1672.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",698.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",668.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",698.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2246.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",705.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",668.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",698.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2371.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2121.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",698.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1497.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",681.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",668.18,2371.2,
"Arthrex Tapered Needle w/Nitinol Loop T-5, 26.5 mm, 1/2 circle",690971,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,96,,,64.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",86.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",91.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",81.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.7,91.2,
"Arthrex Tenodesis Graft Sizing Kit with FiberLoop SutureTape",664294,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1476,,,988.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",395.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1328.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",395.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",413.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1402.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",413.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",885.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",403.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",395.13,1402.2,
"ARTHREX TIGERLOOP #2",663343,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,250.5,,,167.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.06,237.98,
"Arthrex Tightrope Drill, 3.7 mm",691283,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,455.52,,,305.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",127.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",127.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",409.97,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",127.55,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",432.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",387.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",127.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges",273.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",124.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121.94,432.74,
"ARTHREX TIGHTROPE IDS",663334,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1929,,,1292.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",540.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",540.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1736.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",545.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",516.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",540.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1832.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1639.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",540.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1157.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",526.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",516.39,1832.55,
"Arthrex Transtibial ACL with Saw Blade, Disposable Kit",663336,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,1125,,,753.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",315,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",301.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",315,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1012.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",318.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",301.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",315,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1068.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",956.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",315,28,,,,,0,"percent of total billed charges ","28% of total billed charges",675,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",307.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",301.16,1068.75,
"ARTHREX TRIPLE DAM CANNULA TWIST IN 7MM",663898,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,112.14,,,75.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",100.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",106.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",95.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",67.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.02,106.53,
"ARTHREX Twist-In Cannula, Notched, 8.25 mm",663194,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,126,,,84.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",113.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",107.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.73,119.7,
"Arthrex Twist-In Cannula, w/No Squirt Cap, 7 mm ID x 7 cm",690266,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,87.6,,,58.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",78.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",83.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",74.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",52.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.45,83.22,
"ARTHREX VIP 5D PLAN",690467,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,1200,,,804,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",321.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1080,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",339.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",321.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",336,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1140,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1020,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges",720,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",327.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",321.24,1140,
"ARTHREX VIP Glenoid Reamer, Univers Revers Augmented MGS, small",690557,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,3000,,,2010,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2700,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",848.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",803.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",840,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2850,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2550,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",819.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",803.1,2850,
"Arthrex VIP Order #12-26-03-3385",691528,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,1200,,,804,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",321.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1080,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",339.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",321.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",336,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1140,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1020,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges",720,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",327.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",321.24,1140,
"Arthrocentesis, aspiration and/or injection, intermediate joint or bursa, without ultrasound guidanc",220605,CDM,450,RC,C1776,HCPCS,"OUTPATIENT ",,,165,,,110.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",148.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",46.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",140.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.17,156.75,
"ARTHROSCOPIY SHEET DRAPE",690292,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,85.26,,,57.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",76.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.87,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",72.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges",51.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.82,81,
"ARTHROSCOPY LEG CUSHION",663064,CDM,271,RC,C1776,HCPCS,"OUTPATIENT ",,,55.05,,,36.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",49.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",46.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.74,52.3,
"ARTHROSCOPY PUMP TUB",680164,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,213.75,,,143.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",192.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",57.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",203.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",181.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",128.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.22,203.06,
"Arthrosurface 1.5mm Guide Pin ToeMotion",691047,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,567,,,379.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",158.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",151.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",158.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",510.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",151.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",158.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",538.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",481.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",158.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",340.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",154.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",151.79,538.65,
"Arthrosurface 2.0mm Guide Pin",691046,CDM,272,RC,C1776,HCPCS,"OUTPATIENT ",,,432,,,289.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",120.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",115.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",120.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",388.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",122.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",115.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",120.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",410.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",367.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",120.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",259.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",117.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",115.65,410.4,
"Aspartate Aminotransferase",2284450,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,54.5,,,36.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",49.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",46.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.59,51.78,
"Aspergillus fumagatus IgG LC",22660092,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,21.6,,,14.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",19.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.05,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",18.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5.78,20.52,
"AST (SGOT) LC",22001123,CDM,301,RC,C1776,HCPCS,"OUTPATIENT ",,,54.5,,,36.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",49.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",46.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.59,51.78,
"AST (SGOT) P5P LC",22001125,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,54.5,,,36.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",49.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",46.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.59,51.78,
"ASTURA PLATE FACE 6MM",664644,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6000,,,4020,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1606.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1696.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1606.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1680,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5700,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5100,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1638.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1606.2,5700,
"ASTURA SCREW 3.5 X 14MM",664645,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,1180,,,790.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",330.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",315.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",330.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",590,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1062,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",333.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",315.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",330.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1121,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1003,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",330.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",708,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",322.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",315.89,1121,
"ASTURA TI SPACER 14 X 12 X 6MM",664643,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6600,,,4422,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1766.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5940,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1866.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1766.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1848,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6270,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5610,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3960,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1802.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1766.82,6270,
"ATHLETIC SUPPORTER L",680223,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,26.55,,,17.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",23.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.43,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.11,25.22,
"ATHLETIC SUPPORTER M",680222,CDM,270,RC,C1776,HCPCS,"OUTPATIENT ",,,28.08,,,18.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",25.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.52,26.68,
"Attended E-Stim Charges",4411450,CDM,430,RC,C1776,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.85,
"Attended E-Stim Charges",4601450,CDM,420,RC,C1776,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.85,
"Aureobasidium pullulans IgG LC",22660084,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,262,,,175.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",70.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",235.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",70.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",73.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",248.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",222.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",157.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",71.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",70.14,248.9,
"Automated Differential",2285025,CDM,305,RC,C1713,HCPCS,"OUTPATIENT ",,,69.84,,,46.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",62.86,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",41.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.7,66.35,
"Avance Nerve Graft D=1-2mm L=50mm",691005,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,26044,,,17449.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7292.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6971.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7292.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13022,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",23439.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7365.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6971.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7292.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24741.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22137.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7292.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15626.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7112.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6971.98,24741.8,
"AVITENE ULTRA GELFOAM LG",663912,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,173.25,,,116.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",48.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",48.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",155.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",46.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",48.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",164.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",147.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",48.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",103.95,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",47.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.38,164.59,
"Axoguard HA+ Nerve Protector 2 cm x 2 cm",690685,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,10364,,,6943.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2901.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2774.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2901.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5182,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9327.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2930.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2774.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2901.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9845.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8809.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2901.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6218.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2830.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2774.44,9845.8,
"B2 glycoprot I IgA LC",22500591,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,24.42,,,16.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",21.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.54,23.2,
"B2 glycoprot I IgG LC",22500589,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,24.42,,,16.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",21.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.54,23.2,
"B2 glycoprot I IgM LC",22500593,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,24.42,,,16.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",21.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.54,23.2,
"B-2 Microglob, Serum (Serial) LC",2282232,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,89.28,,,59.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",80.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.9,84.82,
"BACTERIA FILTERS",260022,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,1.98,,,1.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.55,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.55,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.53,1.88,
"BAG DECANTER",680102,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,2.65,,,1.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.71,2.52,
"BANDAGE ACE 6",5020387,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,1.71,,,1.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.46,1.62,
"BARD HICKMAN TUNNELER",664127,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,945,,,633.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",264.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",252.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",264.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",850.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",267.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",252.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",264.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",897.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",803.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",264.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",567,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",258.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",252.98,897.75,
"BARRIUM CUPS",1400220,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,81.93,,,54.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",73.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",22.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",77.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",69.64,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",21.93,77.83,
"Bartonella henselae IgG LC",2286611,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,130.17,,,87.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.64,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.85,123.66,
"Bartonella henselae IgM LC",2276611,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,130.17,,,87.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.64,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.85,123.66,
"Bartonella quintana IgG LC",2266611,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,130.17,,,87.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.64,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.85,123.66,
"Bartonella quintana IgM LC",2256611,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,130.17,,,87.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",110.64,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.85,123.66,
"Basic Metabolic Panel",2280048,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,15,,,10.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.02,14.25,
"BCR-ABL1, CML/ALL, PCR, Quant LC",2281206,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,710,,,475.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",198.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",198.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",639,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",200.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",198.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",674.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",603.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",198.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",426,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",193.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.07,674.5,
"BD Bone Density DEXA App Skeleton",1477081,CDM,320,RC,C1713,HCPCS,"OUTPATIENT ",,,499,,,334.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",139.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",133.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",139.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",449.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",141.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",133.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",139.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",474.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",424.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",139.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",299.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",136.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",133.58,474.05,
"BD Bone Density DEXA Axial Skeleton",1477080,CDM,320,RC,C1713,HCPCS,"OUTPATIENT ",,,810,,,542.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",216.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",729,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",216.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",226.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",769.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",688.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",486,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",221.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",216.84,769.5,
"BD Bone Density DEXA Vert Fracture Assmt",1477082,CDM,320,RC,C1713,HCPCS,"OUTPATIENT ",,,134,,,89.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",120.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",127.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",113.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",80.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.87,127.3,
"BD MAXPLUS CLEAR NEEDLELESS CONNECTOR",690241,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,3.9,,,2.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.51,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.09,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.04,3.71,
"Behav/Qual Analysis of Voice and Resonance Charge",4202524,CDM,440,RC,C1713,HCPCS,"OUTPATIENT ",,,380,,,254.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",101.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",342,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",107.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",101.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",361,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",323,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",228,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",103.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",101.73,361,
"Beta hCG Quantitative",2284702,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,78,,,52.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",70.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",74.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",66.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.88,74.1,
"Beta Strep Gp A Culture LC",2287081,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,14,,,9.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.75,13.3,
"Beta-2 Glycoprot I Ab, IgM LC",2276146,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,24.42,,,16.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",21.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.54,23.2,
"Beta-2 Glycoprotein I Ab, IgA LC",2266146,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,24.42,,,16.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",21.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.54,23.2,
"Beta-2 Glycoprotein I Ab, IgM LC",2276146,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,24.42,,,16.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",21.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.54,23.2,
"Beta-2 Glycoprotein I Ab,G/M LC",2286146,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,24.42,,,16.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",21.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.54,23.2,
"Beta-2 Microglobulin, Serum LC",2282232,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,89.28,,,59.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",80.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.9,84.82,
"BETADINE 4OZ",80019229,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,5.34,,,3.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.43,5.07,
"BETADINE PREP TRAY",680195,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,13.26,,,8.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.71,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.55,12.6,
"BETADINE SOLUTION",680079,CDM,270,RC,C1713,HCPCS,"OUTPATIENT ",,,113.76,,,76.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",102.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.45,108.07,
"BF Cell Count w/Diff",2289051,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,140,,,93.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",37.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",126,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",37.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",39.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",133,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",119,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",38.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",37.48,133,
"BFlex? 2 Slim 3.8 Single-Use Bronchoscope",691649,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,778.5,,,521.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",217.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",208.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",217.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",700.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",220.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",208.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",217.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",739.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",661.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",217.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",467.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",212.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",208.4,739.58,
"BFlex? 2 Ultraslim 2.8 Single-Use Bronchoscope",691650,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,930,,,623.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",837,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",260.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",883.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",790.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",558,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.96,883.5,
"Bili Neonatal",2282247,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.04,35.63,
"Bilirubin Direct",2282248,CDM,301,RC,C1713,HCPCS,"OUTPATIENT ",,,32.5,,,21.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",29.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",27.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8.7,30.88,
"Bilirubin Total",2282247,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.04,35.63,
"Bilirubin, Direct LC",22001222,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,32.5,,,21.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",29.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",27.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8.7,30.88,
"Bilirubin, Total LC",2282247,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.04,35.63,
"Bilirubin, Ttl LC",22001100,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.04,35.63,
"Bill Only 86870 RBC Ab ID",BO86870,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,421.71,,,282.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",379.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",400.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",358.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.89,400.62,
"Bill Only ABID Panel",2286870,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,421.71,,,282.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",379.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",400.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",358.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.89,400.62,
"Bill Only ABID Reagent Cell",2286885,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,133.12,,,89.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",119.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.27,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",113.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.64,126.46,
"Bill Only ABO",2286900,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.53,115.43,
"Bill Only ABO/Rh",2286900,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.53,115.43,
"Bill Only ABO/Rh type",2286900,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.53,115.43,
"Bill Only ABSC",2286850,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,127.2,,,85.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",114.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",108.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.05,120.84,
"Bill Only Antigen Type Product",BO86902,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,303,,,203.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",81.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",272.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",85.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",81.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",287.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",257.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",181.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",82.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",81.11,287.85,
"Bill Only Antigen Typing",BO86905,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,606,,,406.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",169.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",162.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",169.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",545.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",171.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",162.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",169.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",575.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",515.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",169.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",363.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",165.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",162.23,575.7,
"Bill Only AP 81455 TARGETED GEBINUC SEQ ANALYSIS >50",SEPA81455,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,5463,,,3660.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1529.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1462.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1529.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4916.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1544.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1462.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1529.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5189.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4643.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1529.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3277.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1491.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1462.45,5189.85,
"Bill Only AP 88106 Smpl Filter Method",SEPA88106,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,89,,,59.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",80.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.83,84.55,
"Bill Only AP 88161 Cytopath Smears Any Other Source",SEPA88161,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,48,,,32.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",43.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",13.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",45.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",40.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",28.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12.85,45.6,
"Bill Only AP 88182 Flow Cyto DNA",SEPA88182,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,127,,,85.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",114.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",107.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34,120.65,
"Bill Only AP 88184 Flow Cytometry 1st Marker",SEPA88184,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,682,,,456.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",190.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",182.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",190.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",613.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",192.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",182.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",190.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",647.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",579.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",190.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",409.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",186.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",182.57,647.9,
"Bill Only AP 88185 Flow Cytometry Ea Addl Marker",SEPA88185,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,161.55,,,108.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",145.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",45.23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",153.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",137.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.25,153.47,
"Bill Only AP 88189 Flow Cytometry 16 + Markers",SEPA88189,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,185,,,123.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",49.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",166.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",49.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",51.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",175.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",157.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",111,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",50.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",49.52,175.75,
"Bill Only AP 88237 Tissue Culture for Neoplastic Disorders",BO88237,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,776.28,,,520.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",217.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",217.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",698.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",219.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",207.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",217.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",737.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",659.84,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",217.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",465.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",212,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207.81,737.47,
"Bill Only AP 88264 Chromosome Analysis Analyze 20-50 Cells",BO88264,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,390.45,,,261.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",109.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",104.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",109.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",351.41,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",110.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",104.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",109.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",370.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",331.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",109.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",234.27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",106.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",104.52,370.93,
"Bill Only AP 88280 Chromosome Analysis Add karyotypes",BO88280,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,271.08,,,181.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",243.97,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",75.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",257.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",230.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",162.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",74.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",72.57,257.53,
"Bill Only AP 88291 Cytomolec Interp & RPT",SEPA88291,CDM,310,RC,C1713,HCPCS,"OUTPATIENT ",,,70,,,46.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.74,66.5,
"Bill Only AP 88313 Special Stains Group II",SEPA88313,CDM,312,RC,C1713,HCPCS,"OUTPATIENT ",,,186.75,,,125.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",49.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",168.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",49.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",52.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",158.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",49.99,177.41,
"Bill Only AP 88314 Histochem Stain W/Frozen",SEPA88314,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,209,,,140.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",58.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",58.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",188.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",55.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",58.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",198.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",177.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",58.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",125.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",57.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",55.95,198.55,
"Bill Only Autoadsorption",2286978,CDM,302,RC,C1776,HCPCS,"OUTPATIENT ",,,491.31,,,329.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",137.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",131.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",137.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",442.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",131.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",137.57,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",466.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",417.61,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",137.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges",294.79,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",134.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",131.52,466.74,
"Bill Only Bone Marrow Smear Interpretation MOL",SEPA85097,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,140,,,93.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",37.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",126,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",37.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",39.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",133,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",119,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",38.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",37.48,133,
"Bill Only Cell Separation",BO86972,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,769.2,,,515.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",692.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",730.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",653.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",461.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",210.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.91,730.74,
"Bill Only Collection and Handling Fee",V03889,CDM,300,RC,C1776,HCPCS,"OUTPATIENT ",,,13.5,,,9.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.61,12.83,
"Bill Only Crossmatch",OB86920,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,245.67,,,164.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",221.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",208.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.77,233.39,
"Bill Only DAT C3",BP86880,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,127.2,,,85.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",114.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",108.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.05,120.84,
"Bill Only DAT IgG",BO86880,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,127.2,,,85.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",114.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",34.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",108.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",34.05,120.84,
"Bill Only Decalcification Procedure MOL",SEPA88311,CDM,310,RC,C1776,HCPCS,"OUTPATIENT ",,,122.4,,,82.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",110.16,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.27,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",116.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",104.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.77,116.28,
"Bill Only Elution",2286860,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,154.5,,,103.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",139.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",43.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",146.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",131.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",92.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.36,146.78,
"Bill Only Enzyme Treat",2286970,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,202.44,,,135.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",182.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",192.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",172.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.19,192.32,
"Bill Only FNA Cytopath Eval",SEPA88173,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,461.7,,,309.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",129.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",129.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",415.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",129.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",438.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",392.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",129.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",277.02,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",126.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.6,438.62,
"Bill Only MYD88 MUT ANALYSIS SO",SEPA81305,CDM,311,RC,C1713,HCPCS,"OUTPATIENT ",,,530,,,355.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",148.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",141.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",148.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",477,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",149.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",141.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",148.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",503.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",450.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",148.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",318,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",144.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",141.88,503.5,
"Bill Only Phenotyping",BO86906,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,674.73,,,452.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",188.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",180.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",188.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",607.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",190.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",180.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",188.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",640.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",573.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",188.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",404.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",184.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",180.63,640.99,
"Bill Only Rh",2286901,CDM,302,RC,C1713,HCPCS,"OUTPATIENT ",,,38,,,25.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",34.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",36.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",32.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.17,36.1,
"Bill Only Thawing Fee",2286927,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,166,,,111.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",149.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",46.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",157.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",141.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",99.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.44,157.7,
"Bill Only Venipuncture",BO36415,CDM,300,RC,C1713,HCPCS,"OUTPATIENT ",,,13,,,8.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.48,12.35,
"BK Quant PCR (Urine) LC",2297799,CDM,306,RC,87799,HCPCS,"OUTPATIENT ",,,487.2,,,326.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",438.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",462.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",414.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",292.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",58.88,462.84,
"BKV Quant PCR (Plasma) LC",2287799,CDM,306,RC,87799,HCPCS,"OUTPATIENT ",,,487.2,,,326.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",438.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",462.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",414.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",292.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",58.88,462.84,
"Bladder Scan",4051798,CDM,761,RC,51798,HCPCS,"OUTPATIENT ",,,257.5,,,172.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",68.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",231.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",68.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",72.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",244.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",218.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",154.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",70.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",68.93,244.63,
"BLOOD CULTURE",2287040,CDM,306,RC,87040,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2.94,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,282.24,169.34,282.24,"1 through 10",other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.98,100,,13.31,13.31,13.31,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.94,177.65,
"Blood Culture",2287040,CDM,306,RC,87040,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.97,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,282.24,169.34,282.24,"1 through 10",other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.98,100,,13.31,13.31,13.31,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.97,177.65,
"Blood Culture x 2",2287040,CDM,306,RC,87040,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,282.24,169.34,282.24,"1 through 10",other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.98,100,,13.31,13.31,13.31,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.28,177.65,
"Blood Culture, Routine LC",2287040,CDM,306,RC,87040,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,282.24,169.34,282.24,"1 through 10",other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.98,100,,13.31,13.31,13.31,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.28,177.65,
"Blood drawn - Central Line Activity.",600084,CDM,761,RC,36591,HCPCS,"OUTPATIENT ",,,469.5,,,314.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",125.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",422.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",132.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",125.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",131.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",446.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",399.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",131.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",281.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",125.69,446.03,
"Blood Gas Analysis",2682805,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.28,160.55,
"Blood Gas Arterial",2682804,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.92,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.92,160.55,
"Blood Gas Arterial plus Electrolytes RT",2682803,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",41.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",35.69,160.55,
"Blood Gas Arterial RT",2682804,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",41.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",35.69,160.55,
"Blood Gas Capillary",2682805,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",41.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",35.69,160.55,
"Blood Gas Venous",2682804,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",102.34,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",35.69,160.55,
"Blood Gas Venous plus Electrolytes RT",2682805,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",74.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",35.69,160.55,
"Blood Gas Venous RT",2682804,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",74.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",35.69,160.55,
"Blood Gas Venous RT",2682804,CDM,301,RC,82805,HCPCS,"OUTPATIENT ",,,169,,,113.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",152.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",74.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,127.40,88.20,127.40,"1 through 10",other,"not separately reimbursment",47.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",35.69,160.55,
"Blood Glucose Monitoring POC RE",282692,CDM,301,RC,82962,HCPCS,"OUTPATIENT ",,,19.5,,,13.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",17.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",74.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,25.97,25.97,25.97,"1 through 10",other,"not separately reimbursment",5.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",16.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.94,74.88,
"Blood Unit Culture",2287040,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",74.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
"Blood Urea Nitrogen",2284520,CDM,301,RC,84520,HCPCS,"OUTPATIENT ",,,119,,,79.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",107.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",74.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,89.67,89.67,91.13,13,other,"not separately reimbursment",33.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",33.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",113.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",101.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",71.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.96,113.05,
"BMP (8) LC",22322758,CDM,300,RC,80048,HCPCS,"OUTPATIENT ",,,15,,,10.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",13.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",74.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,5.83,5.83,5.83,"1 through 10",other,"not separately reimbursment",4.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.65,100,,10.91,10.91,10.91,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",4.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",12.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,74.88,
"Body Fluid Culture",2287071,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",41.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
"Body Fluid Differential",2289051,CDM,310,RC,89051,HCPCS,"OUTPATIENT ",,,140,,,93.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",126,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",102.34,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",39.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",133,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",2.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",119,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.21,133,
"Bone Biopsy Deep",1600225,CDM,359,RC,20225,HCPCS,"OUTPATIENT ",,,1465,,,981.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",410.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",392.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",410.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1318.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",414.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",392.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",410.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1391.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1245.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",410.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",879,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",400.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",392.18,1391.75,
"Bone Biopsy Superficial",1600220,CDM,359,RC,20220,HCPCS,"OUTPATIENT ",,,1465,,,981.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",410.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",392.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",410.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1318.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",414.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",392.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",410.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1391.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1245.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",410.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",879,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",400.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",392.18,1391.75,
"Bone Marrow Biopsy",1638222,CDM,350,RC,38222,HCPCS,"OUTPATIENT ",,,250,,,167.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.93,237.5,
"Bone Marrow Biopsy",1638222,CDM,350,RC,38222,HCPCS,"OUTPATIENT ",,,250,,,167.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.93,237.5,
"C difficile Toxin Gene NAA LC",2287493,CDM,306,RC,87493,HCPCS,"OUTPATIENT ",,,90.5,,,60.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",81.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",76.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.23,85.98,
"C difficile Toxins A+B, EIA LC",2287324,CDM,306,RC,87324,HCPCS,"OUTPATIENT ",,,331,,,221.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",92.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",314.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",281.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.69,314.45,
"C difficile, Cytotoxin B LC",22108448,CDM,300,RC,87230,HCPCS,"OUTPATIENT ",,,123,,,82.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.14,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",110.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",116.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",104.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.57,116.85,
"C001-IgE Penicilloyl G LC",2200002,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"C002-IgE Penicilloyl V LC",2200003,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"C1 Esterase Inhibitor, Func LC",2286161,CDM,300,RC,86161,HCPCS,"OUTPATIENT ",,,404,,,270.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",363.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.98,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",113.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",383.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",343.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",242.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.98,383.8,
"C1 Esterase Inhibitor, Serum LC",2256160,CDM,302,RC,86160,HCPCS,"OUTPATIENT ",,,164.94,,,110.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.91,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",140.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.1,156.69,
"CA 125, Serum (Serial) LC",2286304,CDM,300,RC,86304,HCPCS,"OUTPATIENT ",,,53.5,,,35.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.55,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",50.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.55,50.83,
"CA 19-9 (Serial) LC",2286301,CDM,300,RC,86301,HCPCS,"OUTPATIENT ",,,96,,,64.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",86.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",26.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",91.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",81.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,91.2,
"CA 19-9 LC",2286301,CDM,300,RC,86301,HCPCS,"OUTPATIENT ",,,96,,,64.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",86.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",26.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",91.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",81.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,91.2,
"CA 27.29 LC",2276300,CDM,302,RC,86300,HCPCS,"OUTPATIENT ",,,86,,,57.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",77.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",24.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",81.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",73.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",51.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,81.7,
"Calcitonin, Serum LC",2282308,CDM,301,RC,82308,HCPCS,"OUTPATIENT ",,,147.36,,,98.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.82,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",132.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",41.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",139.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",34.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",125.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,139.99,
"Calcitriol(1,25 di-OH Vit D) LC",2282652,CDM,301,RC,82652,HCPCS,"OUTPATIENT ",,,395.24,,,264.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.4,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.92,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",355.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.4,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",375.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",49.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",335.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,375.48,
"Calcium Level Total",2282310,CDM,301,RC,82310,HCPCS,"OUTPATIENT ",,,65.45,,,43.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.09,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",58.91,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",18.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",62.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",55.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",39.27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,62.18,
"Calcium, 24Hr Urine LC",2292340,CDM,301,RC,82340,HCPCS,"OUTPATIENT ",,,91.52,,,61.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.94,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,86.94,
"Calcium, Ionized, Serum LC",2282330,CDM,301,RC,82330,HCPCS,"OUTPATIENT ",,,60.48,,,40.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54.43,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36.29,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.2,57.46,
"Calprotectin, Fecal LC",2283993,CDM,306,RC,83993,HCPCS,"OUTPATIENT ",,,117.6,,,78.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.98,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",105.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",38.71,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",33.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",32.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",111.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",99.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",70.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",24.68,111.72,
"Campylobacter Cult Prelim LC",2287045,CDM,306,RC,87045,HCPCS,"OUTPATIENT ",,,42,,,28.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",37.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",11.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",39.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",35.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.24,39.9,
"Cancer Antigen (CA) 125 LC",2286304,CDM,300,RC,86304,HCPCS,"OUTPATIENT ",,,53.5,,,35.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",38.71,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",50.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.98,50.83,
"Carbamazepine Level",2280156,CDM,301,RC,80156,HCPCS,"OUTPATIENT ",,,142,,,95.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.02,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",127.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",35.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",39.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",134.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",120.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.31,134.9,
"Carbamazepine(Tegretol),S LC",2280156,CDM,301,RC,80156,HCPCS,"OUTPATIENT ",,,142,,,95.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.02,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",127.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",39.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",134.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",120.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,134.9,
"Carbon Monoxide LC",2282375,CDM,300,RC,82375,HCPCS,"OUTPATIENT ",,,15,,,10.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.62,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.96,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",13.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.87,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.62,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",4.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.69,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",12.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.69,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.62,17.87,
"Cardiac Event Monitor",2693271,CDM,731,RC,93271,HCPCS,"OUTPATIENT ",,,2132,,,1428.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",596.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",570.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",596.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1918.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",602.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",570.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",596.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2025.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1812.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",596.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1279.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",582.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",570.74,2025.4,
"Cardiac Stress Test",2693015,CDM,482,RC,93015,HCPCS,"OUTPATIENT ",,,2832.5,,,1897.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",758.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2549.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1028.58,1028.58,1028.58,"1 through 10",other,"not separately reimbursment",801.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",758.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",793.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2690.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2407.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1699.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",773.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",758.26,2690.88,
"Cardiolipin IgA Ab LC",2266147,CDM,302,RC,86147,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",31.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.89,78.85,
"Cardiolipin IgG LC",22500575,CDM,300,RC,86147,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",31.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.89,78.85,
"Cardiolipin IgM LC",22500571,CDM,300,RC,86147,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.86,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",31.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.86,78.85,
Cardioversion,664230,CDM,360,RC,92960,HCPCS,"OUTPATIENT ",,,4555,,,3051.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1219.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4099.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1288.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1219.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1275.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4327.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3871.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2733,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1243.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1219.37,4327.25,
"CASPR2 Antibody, Cell-based IFA LC",22505575F,CDM,301,RC,86255,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.76,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,325.97,325.97,325.97,"1 through 10",other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.76,376.2,
"Cataract Extraction with IOL",666984,CDM,360,RC,66984,HCPCS,"OUTPATIENT ",,,4390,,,2941.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1229.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1175.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1229.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3951,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1559.84,1533.50,1775.00,"1 through 10",other,"not separately reimbursment",1241.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1175.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1229.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4170.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3731.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1229.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2634,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1198.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1175.2,4170.5,
"Catecholamines, Plasma LC",2262384,CDM,301,RC,82384,HCPCS,"OUTPATIENT ",,,277,,,185.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",77.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",77.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",249.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.81,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",31.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",77.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",263.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",235.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",77.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",166.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",24.81,263.15,
"Catecholamines,Ur.,Free,24 Hr LC",2272384,CDM,300,RC,82384,HCPCS,"OUTPATIENT ",,,277,,,185.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",77.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",77.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",249.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",31.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",77.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",263.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",235.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",77.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",166.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",31.75,263.15,
"CBC w/ Differential",2285025,CDM,305,RC,85025,HCPCS,"OUTPATIENT ",,,98,,,65.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.77,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",88.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,132.30,96.09,132.30,11,other,"not separately reimbursment",27.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.77,100,,9.56,9.56,9.56,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",27.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",93.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",83.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",58.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.77,93.1,
"CBC w/ Differential LC",2285025,CDM,305,RC,85025,HCPCS,"OUTPATIENT ",,,98,,,65.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.77,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",88.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,132.30,96.09,132.30,11,other,"not separately reimbursment",27.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.77,100,,9.56,9.56,9.56,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",27.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",93.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",83.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",58.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.77,93.1,
"CBC w/ Manual Differential",2285027,CDM,305,RC,85027,HCPCS,"OUTPATIENT ",,,106,,,71.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",95.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,103.88,87.38,103.88,"1 through 10",other,"not separately reimbursment",29.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",29.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",100.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",90.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.14,100.7,
"CBC without Differential",2285027,CDM,305,RC,85027,HCPCS,"OUTPATIENT ",,,106,,,71.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",95.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,103.88,87.38,103.88,"1 through 10",other,"not separately reimbursment",29.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",29.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",100.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",90.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,100.7,
"CBC, No Differential/Platelet LC",22028142,CDM,305,RC,85027,HCPCS,"OUTPATIENT ",,,106,,,71.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",95.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,103.88,87.38,103.88,"1 through 10",other,"not separately reimbursment",29.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",29.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",100.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",90.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,100.7,
"CBC, Platelet, No Differential LC",2285027,CDM,305,RC,85027,HCPCS,"OUTPATIENT ",,,106,,,71.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",95.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,103.88,87.38,103.88,"1 through 10",other,"not separately reimbursment",29.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",29.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",100.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",90.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.69,100.7,
"CCP Antibodies IgG/IgA LC",2286200,CDM,302,RC,86200,HCPCS,"OUTPATIENT ",,,263.75,,,176.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",237.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",73.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",250.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",224.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",158.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.69,250.56,
"CD4/CD8 Ratio Profile LC",2286360,CDM,302,RC,86360,HCPCS,"OUTPATIENT ",,,86.4,,,57.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",64.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",77.76,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",26.53,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",24.19,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",82.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",60.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",73.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges",51.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",60.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",24.19,82.08,
"CEA LC",2282378,CDM,301,RC,82378,HCPCS,"OUTPATIENT ",,,409.5,,,274.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",114.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.86,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",114.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",368.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.44,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.86,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",114.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",389.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",348.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",114.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",245.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.86,389.03,
"Celiac Disease Panel LC",2223516,CDM,300,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.44,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.69,247.48,
"Cell Count w/ Diff Body Fluid 3 part",2289051,CDM,310,RC,89051,HCPCS,"OUTPATIENT ",,,126,,,84.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",113.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",35.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",2.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",107.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.21,119.7,
"Centromere Pattern LC",2276038,CDM,300,RC,86235,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.65,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.86,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",21.86,213.75,
"Cerebrospinal Fluid Culture",2287071,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.86,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
"Ceruloplasmin LC",2282390,CDM,301,RC,82390,HCPCS,"OUTPATIENT ",,,135.13,,,90.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",121.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",128.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",114.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",81.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.51,128.37,
"Chlamydia trachomatis DNA -GeneXpert",2287491,CDM,301,RC,87491,HCPCS,"OUTPATIENT ",,,32,,,21.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",28.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",27.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.96,30.4,
"Chlamydia trachomatis, NAA LC",2287491,CDM,301,RC,87491,HCPCS,"OUTPATIENT ",,,32,,,21.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",28.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",27.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.96,30.4,
"Chloride Level 24 Hour Urine",2292436,CDM,301,RC,82436,HCPCS,"OUTPATIENT ",,,42.99,,,28.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.91,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",38.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.45,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.79,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.45,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.32,40.84,
"Chloride Level Urine",2282436,CDM,301,RC,82436,HCPCS,"OUTPATIENT ",,,42.99,,,28.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.91,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",38.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.45,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.79,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.45,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.32,40.84,
Chol,2282465,CDM,301,RC,82465,HCPCS,"OUTPATIENT ",,,69.59,,,46.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.98,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",62.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",19.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.58,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",59.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",41.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.58,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.47,66.11,
"Cholesterol Total LC",22001067,CDM,300,RC,82465,HCPCS,"OUTPATIENT ",,,69.59,,,46.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.98,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",62.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",19.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.58,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",59.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",41.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.58,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.47,66.11,
"Chromium, Plasma LC",2282495,CDM,301,RC,82495,HCPCS,"OUTPATIENT ",,,354.64,,,237.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",99.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",99.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",319.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",99.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",336.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",301.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",99.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",212.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",21.32,336.91,
"Chromogranin A LC",2286316,CDM,302,RC,86316,HCPCS,"OUTPATIENT ",,,891,,,596.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",249.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",249.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",801.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",251.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",249.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",846.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",757.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",249.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",534.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.68,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,846.45,
"Chronic Urticaria PD-BAT LC",2286352,CDM,302,RC,86352,HCPCS,"OUTPATIENT ",,,555,,,371.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",155.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",148.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",155.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.75,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",499.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",148.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",155.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",527.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",471.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",155.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",333,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",151.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",148.57,527.25,
CK-MB,2282553,CDM,301,RC,82553,HCPCS,"OUTPATIENT ",,,153.5,,,102.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.52,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",138.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",43.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.52,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",145.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.81,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",130.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",92.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.81,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,145.83,
"CLL FISH Panel LC",2288275,CDM,302,RC,88271,HCPCS,"OUTPATIENT ",,,859.95,,,576.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",240.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",240.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",773.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",243.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",240.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",816.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",27.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",730.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",240.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",515.97,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.1,816.95,
"Closed Elbow Dis W/o Anes TechFee",224600,CDM,450,RC,24600,HCPCS,"OUTPATIENT ",,,315,,,211.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",88.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",84.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",88.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",283.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",84.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",88.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",299.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",267.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",88.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",189,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",86.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",84.33,299.25,
"Clostridium Difficile",2287493,CDM,306,RC,87493,HCPCS,"OUTPATIENT ",,,90.5,,,60.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",81.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",76.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.23,85.98,
"Clostridium Difficile (GeneXpert)",2287493,CDM,306,RC,87493,HCPCS,"OUTPATIENT ",,,90.5,,,60.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",81.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",76.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.23,85.98,
"Clozapine (Clozaril), Serum LC",2480346,CDM,301,RC,80346,HCPCS,"OUTPATIENT ",,,192,,,128.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.26,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",172.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.26,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",182.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",163.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",115.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.1,182.4,
"CMP (14) LC",2280053,CDM,301,RC,80053,HCPCS,"OUTPATIENT ",,,47,,,31.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",42.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,63.21,14.21,63.21,16,other,"not separately reimbursment",13.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",44.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",28.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,44.65,
"CMV PCR LC",2272000,CDM,300,RC,87496,HCPCS,"OUTPATIENT ",,,84,,,56.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",75.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",79.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",71.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",50.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.77,79.8,
"CMV Quant DNA PCR (Plasma) LC",2287497,CDM,300,RC,87497,HCPCS,"OUTPATIENT ",,,821.46,,,550.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",739.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",232.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",780.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",698.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",492.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.77,780.39,
"Cobalt, Plasma LC",2283019,CDM,301,RC,83018,HCPCS,"OUTPATIENT ",,,175.89,,,117.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",158.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",167.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",28.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",149.51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",105.53,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.77,167.1,
"Cold Agglutinin Titer, Quant LC",2266157,CDM,300,RC,86157,HCPCS,"OUTPATIENT ",,,68,,,45.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.09,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",61.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",19.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",64.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",57.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",40.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.14,64.6,
"Collection successful - Venipuncture Results",ONC36415,CDM,300,RC,36415,HCPCS,"OUTPATIENT ",,,8.45,,,5.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",7.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,8.37,7.78,8.45,"1 through 10",other,"not separately reimbursment",2.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.26,8.03,
"COLLECTION: Arterial Draw",2613660,CDM,410,RC,36600,HCPCS,"OUTPATIENT ",,,405.26,,,271.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",108.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",364.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",108.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",113.47,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",385,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",344.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges",243.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",108.49,385,
"COLLECTION: Capillary",2236416,CDM,300,RC,36416,HCPCS,"OUTPATIENT ",,,14,,,9.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.75,13.3,
"COLLECTION: Venous Draw",2236415,CDM,300,RC,36415,HCPCS,"OUTPATIENT ",,,8.45,,,5.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",7.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,8.37,7.78,8.45,"1 through 10",other,"not separately reimbursment",2.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.26,8.03,
Colonoscopy,610019,CDM,750,RC,45378,HCPCS,"OUTPATIENT ",,,4733,,,3171.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1325.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1267.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1325.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4259.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1487.43,1487.43,1487.43,"1 through 10",other,"not separately reimbursment",1338.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1267.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1325.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4496.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4023.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1325.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2839.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1292.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1267.02,4496.35,
"COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S)",645398,CDM,360,RC,45398,HCPCS,"OUTPATIENT ",,,1375,,,921.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",385,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",368.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",385,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1237.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",368.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",385,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1306.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1168.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",385,28,,,,,0,"percent of total billed charges ","28% of total billed charges",825,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",375.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",368.09,1306.25,
"Compatible - Serological Immediate Spin",2218692,CDM,302,RC,86920,HCPCS,"OUTPATIENT ",,,168,,,112.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",151.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",47.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",159.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",142.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",100.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.97,159.6,
"Compatible - XM AHG Gel Interp",22286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
"Compatible - XM AHG Tube Interp",2286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
"Complement C3, S LC",2286160,CDM,302,RC,86160,HCPCS,"OUTPATIENT ",,,164.94,,,110.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",140.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.47,156.69,
"Complement C3, Serum LC",2286160,CDM,302,RC,86160,HCPCS,"OUTPATIENT ",,,164.94,,,110.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.71,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",140.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.1,156.69,
"Complement C4 LC",2276160,CDM,302,RC,86160,HCPCS,"OUTPATIENT ",,,164.94,,,110.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.71,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",140.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.1,156.69,
"Complement C4, Serum LC",2276160,CDM,302,RC,86160,HCPCS,"OUTPATIENT ",,,164.94,,,110.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",140.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.1,156.69,
"Complement, Total (CH50) LC",2286162,CDM,302,RC,86162,HCPCS,"OUTPATIENT ",,,46.08,,,30.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.93,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",29.08,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.17,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.9,43.78,
"Comprehensive Metabolic Panel",2280053,CDM,301,RC,80053,HCPCS,"OUTPATIENT ",,,47,,,31.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",42.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",50.34,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,63.21,14.21,63.21,16,other,"not separately reimbursment",13.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",44.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",28.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.16,50.34,
"Computer XM OK - Computer Crossmatch Interp",2286923,CDM,300,RC,86923,HCPCS,"OUTPATIENT ",,,95,,,63.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,52.16,36.48,67.84,"1 through 10",other,"not separately reimbursment",26.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",90.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.43,90.25,
"Consult to Dietitian Adult",9900002,CDM,949,RC,97802,HCPCS,"OUTPATIENT ",,,70.5,,,47.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.87,66.98,
"COOMBS DIRECT",2286880,CDM,302,RC,86880,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.75,57,
"Coombs', Direct LC",2286880,CDM,302,RC,86880,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.58,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.75,57,
"Copper, Serum LC",2282526,CDM,301,RC,82525,HCPCS,"OUTPATIENT ",,,161.03,,,107.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.06,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",144.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",36.55,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",45.09,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",152.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",136.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.62,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.61,152.98,
"Coronavirus SARS Ag (Sofia)",2287426,CDM,300,RC,87426,HCPCS,"OUTPATIENT ",,,37,,,24.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",33.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.78,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,36.26,25.96,36.26,"1 through 10",other,"not separately reimbursment",10.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",36.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.36,36.9,
"Corrected - Serological Immediate Spin",2218692,CDM,302,RC,86920,HCPCS,"OUTPATIENT ",,,168,,,112.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",151.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",47.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",159.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",142.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",100.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.97,159.6,
"Corrected - XM AHG Tube Interp",2286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
"Cortisol - AM LC",2272533,CDM,301,RC,82533,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",31.63,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",20.5,177.65,
"Cortisol - PM LC",2262533,CDM,301,RC,82533,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.82,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.82,177.65,
"Cortisol LC",2282533,CDM,301,RC,82533,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.82,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.82,177.65,
"Cortisol, Urinary Free LC",2292530,CDM,301,RC,82530,HCPCS,"OUTPATIENT ",,,49.68,,,33.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.02,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.71,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.02,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.91,47.2,
"Cortisone, Serum, LCMS LC",2282530,CDM,301,RC,82533,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.91,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",19.23,177.65,
"Cortisone, Urine LC",2282530,CDM,301,RC,82530,HCPCS,"OUTPATIENT ",,,49.68,,,33.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.02,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.71,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.02,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.91,47.2,
"C-Peptide, Serum LC",2284681,CDM,301,RC,84681,HCPCS,"OUTPATIENT ",,,77.22,,,51.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.85,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",69.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.65,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",21.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",73.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",65.64,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.33,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",19.98,73.36,
"CPM Initial Fit Charge",46019059,CDM,420,RC,97110,HCPCS,"OUTPATIENT ",,,125.5,,,84.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,141.96,68.01,413.78,"1 through 10",other,"not separately reimbursment",35.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.6,119.23,
"C-Reactive Protein",2286140,CDM,302,RC,86140,HCPCS,"OUTPATIENT ",,,19.5,,,13.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",17.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,23.67,21.43,25.90,"1 through 10",other,"not separately reimbursment",5.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",16.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.46,18.53,
"C-Reactive Protein, Cardiac LC",2286141,CDM,300,RC,86141,HCPCS,"OUTPATIENT ",,,128.7,,,86.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",115.83,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",36.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",122.27,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",109.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",77.22,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.16,122.27,
"C-Reactive Protein, Quant LC",2286410,CDM,302,RC,86140,HCPCS,"OUTPATIENT ",,,19.5,,,13.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",17.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,23.67,21.43,25.90,"1 through 10",other,"not separately reimbursment",5.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",16.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.46,18.53,
"Creatine Kinase",2282550,CDM,301,RC,82550,HCPCS,"OUTPATIENT ",,,114.5,,,76.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",103.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,57.94,35.30,80.58,"1 through 10",other,"not separately reimbursment",32.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",32.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",97.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,108.78,
"Creatine Kinase (CK), MB LC",2282553,CDM,301,RC,82553,HCPCS,"OUTPATIENT ",,,153.5,,,102.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.52,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",138.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",43.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.52,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",145.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.81,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",130.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",92.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.81,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.16,145.83,
"Creatine Kinase,Total LC",2282550,CDM,301,RC,82550,HCPCS,"OUTPATIENT ",,,114.5,,,76.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",103.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,57.94,35.30,80.58,"1 through 10",other,"not separately reimbursment",32.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",32.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",97.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,108.78,
Creatinine,2282565,CDM,301,RC,82565,HCPCS,"OUTPATIENT ",,,134.5,,,90.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",121.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,71.98,71.98,114.77,12,other,"not separately reimbursment",38.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",127.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",114.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",80.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,127.78,
"Creatinine Clearance",2282575,CDM,301,RC,82575,HCPCS,"OUTPATIENT ",,,79.56,,,53.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.88,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",71.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.88,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",22.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",75.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",67.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",47.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.88,75.58,
"Creatinine Level 24 Hour Urine",2292570,CDM,301,RC,82570,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,26.29,16.59,34.66,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.51,46.55,
"Creatinine Urine",2282570,CDM,301,RC,82570,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.54,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,26.29,16.59,34.66,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.51,46.55,
"Creatinine, U LC",22013672,CDM,300,RC,82570,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.54,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,26.29,16.59,34.66,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.51,46.55,
"Critical Care Ill/Injured Patient Addl 30 Min 99292",2699292,CDM,450,RC,99292,HCPCS,"OUTPATIENT ",,,527,,,353.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",141.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1400,100,,,,,0,"case rate ","pays based on per visit rate ",474.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",149.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",141.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",500.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",447.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",316.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",143.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",141.08,1400,
"CRMP-5 IgG LC",22505575G,CDM,301,RC,86255,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,325.97,325.97,325.97,"1 through 10",other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.48,376.2,
"Cryoglobulin, Ql, Serum, Rflx LC",2282595,CDM,301,RC,82595,HCPCS,"OUTPATIENT ",,,87,,,58.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",78.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",24.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",82.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",73.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",52.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.14,82.65,
"Cryptosporidium Antigen",2237828,CDM,306,RC,87328,HCPCS,"OUTPATIENT ",,,69.51,,,46.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",62.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",19.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",59.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",41.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.48,66.03,
"Cryptosporidium Antigen Detection",2287272,CDM,306,RC,87328,HCPCS,"OUTPATIENT ",,,69.51,,,46.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",62.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",19.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",59.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",41.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.48,66.03,
"Crystal,Synovial/Joint Fl LC",2289060,CDM,310,RC,89060,HCPCS,"OUTPATIENT ",,,49.44,,,33.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.02,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.99,46.97,
"CSF Cell Count w/Diff",2279050,CDM,310,RC,89050,HCPCS,"OUTPATIENT ",,,53.76,,,36.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.05,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.95,51.07,
"CSF Differential",2289051,CDM,310,RC,89051,HCPCS,"OUTPATIENT ",,,140,,,93.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",126,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",39.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",133,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",2.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",119,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.21,133,
"CT 3D Reconstruction w/o Workstation",1676376,CDM,350,RC,76376,HCPCS,"OUTPATIENT ",,,535,,,358.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",149.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",143.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",149.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.96,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",481.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",143.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",149.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",508.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",454.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",149.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",321,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",146.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.96,508.25,
"CT Abdomen and Pelvis w/ + w/o Contrast",1674178,CDM,352,RC,74178,HCPCS,"OUTPATIENT ",,,4839.5,,,3242.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1295.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",779.92,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4355.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1575.04,1575.04,1575.04,"1 through 10",other,"not separately reimbursment",1368.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1295.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1355.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4597.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4113.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2903.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1321.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",779.92,4597.53,
"CT Abdomen and Pelvis w/ Contrast",1674177,CDM,352,RC,74177,HCPCS,"OUTPATIENT ",,,7730.31,,,5179.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2069.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",666.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6957.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1881.35,1098.74,3098.42,11,other,"not separately reimbursment",2186.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2069.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2164.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7343.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6570.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4638.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2111.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",666.64,7343.79,
"CT Abdomen and Pelvis w/o Contrast",1674176,CDM,352,RC,74176,HCPCS,"OUTPATIENT ",,,4565,,,3058.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1278.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1222.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1278.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",446.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4108.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,631.63,295.55,814.71,"1 through 10",other,"not separately reimbursment",1290.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1222.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1278.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4336.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3880.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1278.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2739,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1246.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",446.83,4336.75,
"CT Abdomen w/ + w/o Contrast",1674170,CDM,352,RC,74170,HCPCS,"OUTPATIENT ",,,4796.93,,,3213.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1343.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1343.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",618.45,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4317.24,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1356.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1343.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4557.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4077.39,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1343.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2878.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",618.45,4557.08,
"CT Abdomen w/ Contrast",1674160,CDM,352,RC,74160,HCPCS,"OUTPATIENT ",,,4161.54,,,2788.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1165.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1114.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1165.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",537.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3745.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1136.60,1136.60,1136.60,"1 through 10",other,"not separately reimbursment",1176.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1114.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1165.23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3953.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3537.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1165.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2496.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1136.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",537.43,3953.46,
"CT Abdomen w/o Contrast",1674150,CDM,352,RC,74150,HCPCS,"OUTPATIENT ",,,3311.8,,,2218.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",927.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",886.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",927.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",344.93,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2980.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",936.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",886.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",927.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3146.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2815.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",927.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1987.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",904.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",344.93,3146.21,
"CT Angio Abdomen",1674175,CDM,352,RC,74175,HCPCS,"OUTPATIENT ",,,3410.46,,,2285.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",954.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",912.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",954.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",783.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3069.41,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",964.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",912.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",954.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3239.94,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2898.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",954.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2046.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",931.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",783.56,3239.94,
"CT Angio Abdomen and Pelvis",1674174,CDM,352,RC,74174,HCPCS,"OUTPATIENT ",,,7199.5,,,4823.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2015.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2015.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",963.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6479.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2015.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6839.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6119.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2015.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4319.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",963.08,6839.53,
"CT Angio Abdomen Aorta + Iliofemoral",1675635,CDM,350,RC,75635,HCPCS,"OUTPATIENT ",,,3151,,,2111.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",882.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",843.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",882.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",868.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2835.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",891.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",843.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",882.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2993.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2678.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",882.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1890.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",860.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",843.52,2993.45,
"CT Angio Brain/Head",1670496,CDM,351,RC,70496,HCPCS,"OUTPATIENT ",,,4229,,,2833.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1184.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1132.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1184.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",962.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3806.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1195.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1132.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1184.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4017.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3594.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1184.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2537.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1154.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",962.29,4017.55,
"CT Angio Chest",1671275,CDM,352,RC,71275,HCPCS,"OUTPATIENT ",,,6904.5,,,4626.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1848.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",779.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6214.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,649.18,160.55,1335.23,"1 through 10",other,"not separately reimbursment",1952.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1848.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1933.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6559.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5868.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4142.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1885.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",779.23,6559.28,
"CT Angio Chest + Abd/Pelv w/ + w/o Cont",1671276,CDM,352,RC,74177,HCPCS,"OUTPATIENT ",,,7730.31,,,5179.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2069.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",666.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6957.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1881.35,1098.74,3098.42,11,other,"not separately reimbursment",2186.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2069.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2164.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7343.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6570.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4638.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2111.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",666.64,7343.79,
"CT Angio Chest PE",1671273,CDM,352,RC,71275,HCPCS,"OUTPATIENT ",,,6904.5,,,4626.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1848.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",779.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6214.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,649.18,160.55,1335.23,"1 through 10",other,"not separately reimbursment",1952.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1848.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1933.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6559.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5868.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1933.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4142.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1885.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",779.23,6559.28,
"CT Angio Chest PE + Abd/Pelvis w/ Cont",1600005,CDM,352,RC,74177,HCPCS,"OUTPATIENT ",,,7730.31,,,5179.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2069.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",666.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6957.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1881.35,1098.74,3098.42,11,other,"not separately reimbursment",2186.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2069.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2164.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7343.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6570.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4638.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2111.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",666.64,7343.79,
"CT Angio Chest/Abdomen/Pelvis",1674173,CDM,352,RC,74174,HCPCS,"OUTPATIENT ",,,7199.5,,,4823.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2015.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2015.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",963.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6479.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2015.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6839.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6119.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2015.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4319.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",963.08,6839.53,
"CT Angio Head/Neck",1670496,CDM,351,RC,70496,HCPCS,"OUTPATIENT ",,,4229,,,2833.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1184.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1132.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1184.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",962.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3806.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1195.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1132.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1184.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4017.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3594.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1184.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2537.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1154.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",962.29,4017.55,
"CT Angio Heart/Coronary Arteries",1675574,CDM,350,RC,75574,HCPCS,"OUTPATIENT ",,,7090,,,4750.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1985.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1897.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1985.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",882.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6381,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2005.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1897.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1985.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6735.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6026.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4254,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1936.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",882.42,6735.5,
"CT Angio Lower Extremity Left",1673707,CDM,350,RC,73706,HCPCS,"OUTPATIENT ",,,1877.41,,,1257.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",525.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",502.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",525.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",782.27,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1689.67,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",530.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",502.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",525.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1783.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1595.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",525.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1126.45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",512.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",502.58,1783.54,
"CT Angio Lower Extremity Right",1673706,CDM,350,RC,73706,HCPCS,"OUTPATIENT ",,,1877.41,,,1257.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",525.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",502.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",525.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",782.27,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1689.67,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",530.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",502.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",525.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1783.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1595.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",525.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1126.45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",512.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",502.58,1783.54,
"CT Angio Neck",1670498,CDM,351,RC,70498,HCPCS,"OUTPATIENT ",,,913.5,,,612.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",255.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",244.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",255.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",994.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",822.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,120.05,120.05,120.05,"1 through 10",other,"not separately reimbursment",258.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",244.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",255.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",867.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",776.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",255.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",548.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",249.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",244.54,994.7,
"CT Angio Pelvis",1672191,CDM,352,RC,72191,HCPCS,"OUTPATIENT ",,,3808.35,,,2551.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1066.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1019.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1066.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",773.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3427.52,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1077,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1019.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1066.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3617.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3237.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1066.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2285.01,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1040.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",773.39,3617.93,
"CT Angio Upper Extremity Left",1673207,CDM,350,RC,73206,HCPCS,"OUTPATIENT ",,,3005,,,2013.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",841.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",804.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",841.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",707.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2704.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",849.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",804.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",841.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2854.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2554.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",841.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1803,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",820.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",707.2,2854.75,
"CT Angio Upper Extremity Right",1673206,CDM,350,RC,73206,HCPCS,"OUTPATIENT ",,,3005,,,2013.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",841.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",804.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",841.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",707.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2704.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",849.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",804.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",841.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2854.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2554.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",841.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1803,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",820.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",707.2,2854.75,
"CT Biopsy Bone Deep",1620225,CDM,359,RC,77012,HCPCS,"OUTPATIENT ",,,1156,,,774.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",309.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1040.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",326.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",309.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",323.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1098.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",982.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",693.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",315.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.68,1098.2,
"CT Biopsy Bone Marrow w/ Bone Marrow Asp",1638222,CDM,350,RC,77012,HCPCS,"OUTPATIENT ",,,1156,,,774.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",309.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1040.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",326.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",309.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",323.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1098.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",982.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",693.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",315.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.68,1098.2,
"CT Biopsy Bone Superficial",1620220,CDM,359,RC,77012,HCPCS,"OUTPATIENT ",,,1156,,,774.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",309.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1040.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",326.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",309.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",323.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1098.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",982.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",693.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",315.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.68,1098.2,
"CT Biopsy Lung/Mediastinum",1632405,CDM,350,RC,32408,HCPCS,"OUTPATIENT ",,,1193,,,799.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",334.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",319.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",334.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1073.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",337.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",319.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",334.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1133.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1014.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",334.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",715.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",325.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",319.37,1133.35,
"CT Bone Length Study",1677073,CDM,350,RC,77073,HCPCS,"OUTPATIENT ",,,414.7,,,277.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",116.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",111.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",116.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",75.75,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",373.23,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",111.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",116.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",393.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",352.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",116.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",248.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",113.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",75.75,393.97,
"CT Chest w/ + w/o Contrast",1671270,CDM,352,RC,71270,HCPCS,"OUTPATIENT ",,,3696.1,,,2476.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1034.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",989.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1034.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",613.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3326.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1045.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",989.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1034.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3511.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3141.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1034.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2217.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1009.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",613.2,3511.3,
"CT Chest w/ Cont + Abd/Pel w/ + w/o Cont",167465,CDM,352,RC,74178,HCPCS,"OUTPATIENT ",,,4839.5,,,3242.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1295.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",779.92,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4355.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1575.04,1575.04,1575.04,"1 through 10",other,"not separately reimbursment",1368.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1295.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1355.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4597.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4113.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2903.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1321.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",779.92,4597.53,
"CT Chest w/ Contrast",1671260,CDM,352,RC,71260,HCPCS,"OUTPATIENT ",,,4481.5,,,3002.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1254.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1199.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1254.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",506.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4033.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,951.74,911.52,991.96,"1 through 10",other,"not separately reimbursment",1267.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1199.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1254.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4257.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3809.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1254.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2688.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1223.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",506.71,4257.43,
"CT Chest w/o + Abd/Pelvis w/ + w/o Cont",1674178,CDM,352,RC,74178,HCPCS,"OUTPATIENT ",,,4839.5,,,3242.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1295.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",779.92,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4355.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1575.04,1575.04,1575.04,"1 through 10",other,"not separately reimbursment",1368.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1295.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1355.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4597.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4113.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2903.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1321.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",779.92,4597.53,
"CT Chest w/o Contrast",1671250,CDM,352,RC,71250,HCPCS,"OUTPATIENT ",,,2837,,,1900.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",794.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",759.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",794.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",405.31,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2553.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,457.08,438.31,517.84,"1 through 10",other,"not separately reimbursment",802.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",759.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",794.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2695.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2411.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",794.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1702.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",774.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",405.31,2695.15,
"CT Chest/Abd/Pelvis w/ + w/o Contrast",1674178,CDM,352,RC,74178,HCPCS,"OUTPATIENT ",,,4839.5,,,3242.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1295.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",779.92,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4355.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1575.04,1575.04,1575.04,"1 through 10",other,"not separately reimbursment",1368.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1295.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1355.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4597.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4113.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1355.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2903.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1321.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",779.92,4597.53,
"CT Chest/Abd/Pelvis w/ Contrast",1674179,CDM,352,RC,74177,HCPCS,"OUTPATIENT ",,,7730.31,,,5179.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2069.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",666.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",6957.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1881.35,1098.74,3098.42,11,other,"not separately reimbursment",2186.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2069.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2164.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7343.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6570.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2164.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4638.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2111.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",666.64,7343.79,
"CT Chest/Abd/Pelvis w/o Contrast",1674180,CDM,352,RC,74176,HCPCS,"OUTPATIENT ",,,4565,,,3058.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1278.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1222.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1278.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",446.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4108.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,631.63,295.55,814.71,"1 through 10",other,"not separately reimbursment",1290.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1222.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1278.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4336.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3880.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1278.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2739,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1246.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",446.83,4336.75,
"CT Chest/Abdomen w/ Contrast",1674162,CDM,352,RC,71260,HCPCS,"OUTPATIENT ",,,4282.44,,,2869.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1146.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",506.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3854.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,951.74,911.52,991.96,"1 through 10",other,"not separately reimbursment",1211.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1146.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1199.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4068.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3640.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2569.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1169.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",506.71,4068.32,
"CT Drain Visceral Fluid w/Cath Perc",1675989,CDM,350,RC,75989,HCPCS,"OUTPATIENT ",,,1392,,,932.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",389.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",372.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",389.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",245.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1252.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",393.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",372.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",389.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1322.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1183.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",389.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",835.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",380.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",245.11,1322.4,
"CT Guided Needle Biopsy",1677012,CDM,352,RC,77012,HCPCS,"OUTPATIENT ",,,1156,,,774.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",309.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1040.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",326.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",309.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",323.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1098.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",982.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",693.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",315.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.68,1098.2,
"CT Guided Needle Placement",1677012,CDM,352,RC,77012,HCPCS,"OUTPATIENT ",,,1156,,,774.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",309.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1040.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",326.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",309.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",323.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1098.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",982.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",323.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",693.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",315.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.68,1098.2,
"CT Head w/ + w/o Contrast",1670470,CDM,351,RC,70470,HCPCS,"OUTPATIENT ",,,4085.62,,,2737.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1143.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1093.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1143.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",423.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3677.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1155.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1093.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1143.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3881.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3472.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1143.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2451.37,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1115.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",423.68,3881.34,
"CT Head w/ Contrast",1670460,CDM,351,RC,70460,HCPCS,"OUTPATIENT ",,,1290.24,,,864.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",361.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",345.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",361.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",418.16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1161.22,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",364.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",345.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",361.27,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1225.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1096.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",361.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges",774.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",352.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",345.4,1225.73,
"CT Head w/o Contrast",1670450,CDM,351,RC,70450,HCPCS,"OUTPATIENT ",,,3624.5,,,2428.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1014.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",970.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1014.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",318.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3262.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,662.80,206.01,1119.58,"1 through 10",other,"not separately reimbursment",1025.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",970.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1014.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3443.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3080.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1014.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2174.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",989.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",318.88,3443.28,
"CT Heart Calcium Scoring",1675571,CDM,350,RC,75571,HCPCS,"OUTPATIENT ",,,1100,,,737,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",294.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",217.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",990,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",311.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",294.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",308,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1045,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",935,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges",660,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",300.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",217.76,1045,
"CT Lower Extremity w/ Contrast Left",1673705,CDM,352,RC,73701,HCPCS,"OUTPATIENT ",,,3043.04,,,2038.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",501.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.05,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",501.68,2890.89,
"CT Lower Extremity w/ Contrast Right",1673701,CDM,352,RC,73701,HCPCS,"OUTPATIENT ",,,3043.04,,,2038.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",501.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.05,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",501.68,2890.89,
"CT Lower Extremity w/+w/o Contrast Left",1673703,CDM,352,RC,73702,HCPCS,"OUTPATIENT ",,,2679,,,1794.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",750.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",717.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",750.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",626.66,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2411.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",757.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",717.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",750.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2545.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2277.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",750.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1607.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",731.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",626.66,2545.05,
"CT Lower Extremity w/+w/o Contrast Right",1673702,CDM,352,RC,73702,HCPCS,"OUTPATIENT ",,,2679,,,1794.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",750.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",717.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",750.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",626.66,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2411.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",757.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",717.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",750.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2545.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2277.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",750.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1607.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",731.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",626.66,2545.05,
"CT Lower Extremity w/o Contrast Left",1673704,CDM,352,RC,73700,HCPCS,"OUTPATIENT ",,,2628.98,,,1761.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",703.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",404.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2366.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",703.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.11,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2497.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2234.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1577.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",717.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",404.56,2497.53,
"CT Lower Extremity w/o Contrast Right",1673700,CDM,352,RC,73700,HCPCS,"OUTPATIENT ",,,2628.98,,,1761.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",703.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",404.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2366.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",703.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.11,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2497.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2234.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1577.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",717.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",404.56,2497.53,
"CT Lung Cancer Screening",1671251,CDM,352,RC,71271,HCPCS,"OUTPATIENT ",,,2389.5,,,1600.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",669.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",639.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",669.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2150.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,522.34,522.34,522.34,11,other,"not separately reimbursment",675.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",639.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",669.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2270.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2031.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",669.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1433.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",652.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",639.67,2270.03,
"CT Maxillofacial w/ + w/o Contrast",1670488,CDM,351,RC,70488,HCPCS,"OUTPATIENT ",,,2531,,,1695.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",708.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",677.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",708.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.02,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2277.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",715.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",677.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",708.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2404.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2151.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",708.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1518.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",691.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.02,2404.45,
"CT Maxillofacial w/ Contrast",1670487,CDM,351,RC,70487,HCPCS,"OUTPATIENT ",,,1750.6,,,1172.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",490.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",468.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",490.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",530,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1575.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,77.16,77.16,77.16,"1 through 10",other,"not separately reimbursment",495.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",468.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",490.17,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1663.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1488.01,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",490.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1050.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",478.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",468.64,1663.07,
"CT Maxillofacial w/o Contrast",1670486,CDM,351,RC,70486,HCPCS,"OUTPATIENT ",,,2183,,,1462.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",440.48,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1964.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1371.93,793.51,1655.27,"1 through 10",other,"not separately reimbursment",617.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",584.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",611.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2073.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1855.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1309.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",596.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",440.48,2073.85,
"CT Neck Soft Tissue w/ + w/o Contrast",1670492,CDM,351,RC,70492,HCPCS,"OUTPATIENT ",,,1832.16,,,1227.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",513,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",490.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",513,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",616.91,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1648.94,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",518.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",490.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",513,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1740.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1557.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",513,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1099.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",500.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",490.47,1740.55,
"CT Neck Soft Tissue w/ Contrast",1670491,CDM,351,RC,70491,HCPCS,"OUTPATIENT ",,,2455.2,,,1644.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",687.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",657.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",687.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",517.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2209.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",694.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",657.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",687.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2332.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2086.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",687.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1473.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",670.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",517.88,2332.44,
"CT Neck Soft Tissue w/o Contrast",1670490,CDM,351,RC,70490,HCPCS,"OUTPATIENT ",,,1122.87,,,752.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",314.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",300.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",314.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",430.73,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1010.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",317.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",300.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",314.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1066.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",954.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",314.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",673.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",306.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",300.59,1066.73,
"CT Orbits Sella w/ + w/o Contrast",1670482,CDM,351,RC,70482,HCPCS,"OUTPATIENT ",,,1692,,,1133.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",473.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",452.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",473.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",684.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1522.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",478.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",452.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",473.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1607.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1438.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",473.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1015.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",462.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",452.95,1607.4,
"CT Orbits Sella w/ Contrast",1670481,CDM,351,RC,70481,HCPCS,"OUTPATIENT ",,,2661.23,,,1783.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",745.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",712.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",745.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",618.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2395.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",752.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",712.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",745.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2528.17,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2262.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",745.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1596.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",726.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",618.95,2528.17,
"CT Orbits Sella w/o Contrast",1670480,CDM,351,RC,70480,HCPCS,"OUTPATIENT ",,,1047.5,,,701.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",534.96,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",942.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",280.42,995.13,
"CT Pelvis w/ + w/o Contrast",1672194,CDM,352,RC,72194,HCPCS,"OUTPATIENT ",,,3069,,,2056.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",859.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",821.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",859.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",591.07,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2762.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",867.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",821.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",859.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2915.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2608.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",859.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1841.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",838.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",591.07,2915.55,
"CT Pelvis w/ Contrast",1672193,CDM,352,RC,72193,HCPCS,"OUTPATIENT ",,,1378,,,923.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",385.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",368.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",385.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",527.74,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1240.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",389.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",368.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",385.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1309.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1171.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",385.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",826.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",376.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",368.89,1309.1,
"CT Pelvis w/o Contrast",1672192,CDM,352,RC,72192,HCPCS,"OUTPATIENT ",,,3720.4,,,2492.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1041.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",995.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1041.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",337.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3348.36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1052.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",995.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1041.71,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3534.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3162.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1041.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2232.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1016.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",337.17,3534.38,
"CT Sinus w/ +  w/o Contrast",1670485,CDM,351,RC,70488,HCPCS,"OUTPATIENT ",,,2531,,,1695.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",708.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",677.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",708.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.02,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2277.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",715.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",677.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",708.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2404.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2151.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",708.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1518.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",691.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.02,2404.45,
"CT Sinus w/ Contrast",1670484,CDM,351,RC,70487,HCPCS,"OUTPATIENT ",,,1382,,,925.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",386.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",369.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",386.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",530,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1243.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,77.16,77.16,77.16,"1 through 10",other,"not separately reimbursment",390.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",369.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",386.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1312.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1174.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",386.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",829.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",377.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",369.96,1312.9,
"CT Sinus w/o Contrast",1670483,CDM,351,RC,70486,HCPCS,"OUTPATIENT ",,,2183,,,1462.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",440.48,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1964.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1371.93,793.51,1655.27,"1 through 10",other,"not separately reimbursment",617.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",584.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",611.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2073.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1855.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1309.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",596.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",440.48,2073.85,
"CT Spine Cervical w/ + w/o Contrast",1672127,CDM,352,RC,72127,HCPCS,"OUTPATIENT ",,,2843,,,1904.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",796.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",761.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",796.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",604.16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2558.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",804,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",761.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",796.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2700.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2416.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",796.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1705.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",776.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",604.16,2700.85,
"CT Spine Cervical w/ Contrast",1672126,CDM,352,RC,72126,HCPCS,"OUTPATIENT ",,,2795,,,1872.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",782.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",748.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",782.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",505.92,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2515.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",790.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",748.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",782.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2655.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2375.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",782.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1677,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",763.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",505.92,2655.25,
"CT Spine Cervical w/o Contrast",1672125,CDM,352,RC,72125,HCPCS,"OUTPATIENT ",,,4050,,,2713.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1134,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1084.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1134,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",414.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3645,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1230.94,437.28,1626.66,"1 through 10",other,"not separately reimbursment",1145.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1084.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1134,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3847.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3442.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1134,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2430,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1106.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",414.56,3847.5,
"CT Spine Lumbar w/ + w/o Contrast",1672133,CDM,352,RC,72133,HCPCS,"OUTPATIENT ",,,1674,,,1121.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",468.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",448.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",468.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",604.16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1506.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",473.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",448.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",468.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1590.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1422.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",468.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1004.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",457.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",448.13,1590.3,
"CT Spine Lumbar w/ Contrast",1672132,CDM,352,RC,72132,HCPCS,"OUTPATIENT ",,,2456,,,1645.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",687.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",657.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",687.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",506.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2210.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",694.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",657.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",687.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2333.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2087.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",687.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1473.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",670.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",506.56,2333.2,
"CT Spine Lumbar w/o Contrast",1672131,CDM,352,RC,72131,HCPCS,"OUTPATIENT ",,,2999,,,2009.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",839.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",802.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",839.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",404.52,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2699.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,720.25,718.99,721.51,"1 through 10",other,"not separately reimbursment",848.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",802.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",839.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2849.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2549.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",839.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1799.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",819.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",404.52,2849.05,
"CT Spine Thoracic w/ + w/o Contrast",1672130,CDM,352,RC,72130,HCPCS,"OUTPATIENT ",,,2710,,,1815.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",758.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",725.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",758.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",607.32,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2439,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",766.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",725.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",758.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2574.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2303.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",758.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1626,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",740.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",607.32,2574.5,
"CT Spine Thoracic w/ Contrast",1672129,CDM,352,RC,72129,HCPCS,"OUTPATIENT ",,,2460,,,1648.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",658.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",507.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2214,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",695.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",658.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",688.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2337,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2091,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1476,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",671.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",507.83,2337,
"CT Spine Thoracic w/o Contrast",1672128,CDM,352,RC,72128,HCPCS,"OUTPATIENT ",,,2036.25,,,1364.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",570.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",545.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",570.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",405.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1832.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",575.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",545.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",570.15,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1934.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1730.81,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",570.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1221.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",556.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",405.79,1934.44,
"CT Upper Extremity w/ Contrast Left",1673204,CDM,352,RC,73201,HCPCS,"OUTPATIENT ",,,2917.2,,,1954.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",780.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",494.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2625.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",824.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",780.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",816.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2771.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2479.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1750.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",796.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",494.69,2771.34,
"CT Upper Extremity w/ Contrast Right",1673201,CDM,352,RC,73201,HCPCS,"OUTPATIENT ",,,2917.2,,,1954.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",780.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",494.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2625.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",824.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",780.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",816.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2771.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2479.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1750.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",796.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",494.69,2771.34,
"CT Upper Extremity w/+w/o Contrast Left",1673203,CDM,352,RC,73202,HCPCS,"OUTPATIENT ",,,3967,,,2657.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1110.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1061.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1110.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",627.93,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3570.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1121.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1061.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1110.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3768.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3371.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1110.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2380.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1083.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",627.93,3768.65,
"CT Upper Extremity w/+w/o Contrast Right",1673202,CDM,352,RC,73202,HCPCS,"OUTPATIENT ",,,3967,,,2657.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1110.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1061.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1110.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",627.93,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3570.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1121.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1061.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1110.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3768.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3371.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1110.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2380.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1083.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",627.93,3768.65,
"CT Upper Extremity w/o Contrast Left",1673205,CDM,352,RC,73200,HCPCS,"OUTPATIENT ",,,2917.2,,,1954.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",780.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",403.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2625.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,118.57,118.57,118.57,"1 through 10",other,"not separately reimbursment",824.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",780.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",816.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2771.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2479.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1750.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",796.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",403.29,2771.34,
"CT Upper Extremity w/o Contrast Right",1673200,CDM,352,RC,73200,HCPCS,"OUTPATIENT ",,,2917.2,,,1954.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",780.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",403.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2625.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,118.57,118.57,118.57,"1 through 10",other,"not separately reimbursment",824.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",780.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",816.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2771.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2479.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",816.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1750.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",796.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",403.29,2771.34,
"C-Telopeptide (Endocrine Sciences) LC",2282520,CDM,301,RC,82523,HCPCS,"OUTPATIENT ",,,838,,,561.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",754.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",234.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",796.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",712.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",502.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.5,796.1,
"Culture Identification",2287077,CDM,306,RC,87077,HCPCS,"OUTPATIENT ",,,33.5,,,22.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",30.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",9.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",31.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",28.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.38,37.12,
"Cytomegalovirus (CMV) Ab, IgG LC",2286644,CDM,302,RC,86644,HCPCS,"OUTPATIENT ",,,230.7,,,154.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.17,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",196.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.63,219.17,
"Cytomegalovirus (CMV) Ab, IgM LC",2286645,CDM,300,RC,86645,HCPCS,"OUTPATIENT ",,,72.93,,,48.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.15,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",65.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",69.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",61.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",20.42,69.28,
"D001-IgE D pteronyssinus LC",22602467,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"D002-IgE D farinae LC",22602475,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.12,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"DAT IgG Tube",2286880,CDM,302,RC,86880,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.75,57,
D-Dimer,2285379,CDM,305,RC,85379,HCPCS,"OUTPATIENT ",,,54,,,36.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,40.67,40.67,40.67,"1 through 10",other,"not separately reimbursment",15.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,51.3,
"D-Dimer LC",2285379,CDM,305,RC,85379,HCPCS,"OUTPATIENT ",,,54,,,36.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,40.67,40.67,40.67,"1 through 10",other,"not separately reimbursment",15.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,51.3,
"Deamidated Gliadin Abs, IgA LC",22161652,CDM,300,RC,86258,HCPCS,"OUTPATIENT ",,,40,,,26.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.22,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.22,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,38,
"Deamidated Gliadin Abs, IgG LC",22161693,CDM,300,RC,86258,HCPCS,"OUTPATIENT ",,,40,,,26.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.22,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.22,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,38,
"DHEA, Serum LC",2286626,CDM,301,RC,82626,HCPCS,"OUTPATIENT ",,,365,,,244.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",102.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",102.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",34.74,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",328.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",103.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",31.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",102.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",346.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",310.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",102.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",219,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,346.75,
"DHEA-Sulfate LC",2286627,CDM,300,RC,82627,HCPCS,"OUTPATIENT ",,,331,,,221.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",92.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",314.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",28.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",281.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,314.45,
"DIA Value LC",22017381,CDM,300,RC,86336,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,47.5,
"Diffusion (DLCO) - RT CHARGE PFT",2694720,CDM,460,RC,94729,HCPCS,"OUTPATIENT ",,,210.72,,,141.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",189.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",56.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",200.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",179.11,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",126.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",57.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",56.41,200.18,
"Digoxin Level",2280162,CDM,301,RC,80162,HCPCS,"OUTPATIENT ",,,48.48,,,32.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.25,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",43.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.57,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.09,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,46.06,
"Dilute Prothrombin Time(dPT) LC",22005201,CDM,305,RC,85705,HCPCS,"OUTPATIENT ",,,30,,,20.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.11,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.11,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,28.5,
"Diphtheria Antitoxoid Ab LC",22163710,CDM,300,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,104.72,
"Drug Profile, Ur, 9 Drugs LC",2280307,CDM,301,RC,80307,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.65,53.65,53.65,"1 through 10",other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,179.32,
"Drug Screen 10 w/Conf, WB LC",2280307,CDM,301,RC,80307,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.65,53.65,53.65,"1 through 10",other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,179.32,
"Drug Screen 11 w/Conf, WB LC",2280307,CDM,301,RC,80307,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.65,53.65,53.65,"1 through 10",other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,179.32,
"Drug Screen- Collection (Employee)",2299998,CDM,300,RC,99001,HCPCS,"OUTPATIENT ",,,13.5,,,9.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.61,12.83,
"Drug Screen- Collection (Kit Provided)",2299998,CDM,300,RC,99001,HCPCS,"OUTPATIENT ",,,13.5,,,9.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.61,12.83,
"Drug Screen- Collection Only",2299998,CDM,300,RC,99001,HCPCS,"OUTPATIENT ",,,13.5,,,9.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.61,12.83,
"Drug Screen- Collection Only DOT",2299998,CDM,300,RC,99001,HCPCS,"OUTPATIENT ",,,13.5,,,9.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.61,12.83,
"Drug Screen- Collection plus test",2299998,CDM,300,RC,99001,HCPCS,"OUTPATIENT ",,,13.5,,,9.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",12.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.61,12.83,
"DRUG SCREEN TESTING TO CLINICAL REFERENCE LAB",BP80307,CDM,300,RC,80307,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.65,53.65,53.65,"1 through 10",other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,179.32,
"Drug Screen Urine",2280100,CDM,301,RC,80306,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,86.93,
"Drug Screen Urine POCT",2280306,CDM,302,RC,80306,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,86.93,
"dRVVT Conf Sec LC",22501548,CDM,300,RC,85613,HCPCS,"OUTPATIENT ",,,28.8,,,19.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",25.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",24.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,27.36,
"dRVVT LC",22117891,CDM,305,RC,85613,HCPCS,"OUTPATIENT ",,,28.8,,,19.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",25.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",24.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,27.36,
"dRVVT Scr Sec LC",22501549,CDM,300,RC,85613,HCPCS,"OUTPATIENT ",,,28.8,,,19.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",25.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",24.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,27.36,
"Dry Needling Minutes",4620560,CDM,761,RC,20560,HCPCS,"OUTPATIENT ",,,75,,,50.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",67.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",71.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",63.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.08,71.25,
"E001-IgE Cat Dander LC",22602454,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,86.93,
"E003-IgE Horse Dander LC",2286003,CDM,301,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,86.93,
"E005-IgE Dog Dander LC",22602456,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,86.93,
"E072-IgE Mouse Urine LC",22602689,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,86.93,
"Ear Culture",2247070,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,156.28,
"EBV Ab VCA, IgG LC",2276665,CDM,300,RC,86665,HCPCS,"OUTPATIENT ",,,163.02,,,109.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",146.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",45.65,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",154.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",138.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges",97.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,154.87,
"EBV Ab VCA, IgM LC",2286665,CDM,300,RC,86665,HCPCS,"OUTPATIENT ",,,163.02,,,109.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",146.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",45.65,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",154.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",138.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges",97.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.13,154.87,
"EBV Nuclear Antigen Ab, IgG LC",2286664,CDM,302,RC,86664,HCPCS,"OUTPATIENT ",,,135.13,,,90.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.03,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",121.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",128.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",114.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",81.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.22,128.37,
"EBV PCR Quant (Whole Blood) LC",2287799,CDM,306,RC,87799,HCPCS,"OUTPATIENT ",,,487.2,,,326.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",438.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",462.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",414.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",292.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",58.88,462.84,
"Echocardiogram Complete",2693306,CDM,483,RC,93306,HCPCS,"OUTPATIENT ",,,2410,,,1614.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",674.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",645.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",674.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2169,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,399.51,164.31,454.07,"1 through 10",other,"not separately reimbursment",681.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",645.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",674.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2289.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2048.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",674.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1446,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",658.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",645.16,2289.5,
"Echocardiogram Limited",2693308,CDM,483,RC,93308,HCPCS,"OUTPATIENT ",,,600,,,402,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",168,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",160.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",168,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",540,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",160.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",168,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",570,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",510,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",168,28,,,,,0,"percent of total billed charges ","28% of total billed charges",360,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",163.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",160.62,570,
"Echocardiogram TEE",2693312,CDM,483,RC,93312,HCPCS,"OUTPATIENT ",,,1422,,,952.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",380.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1279.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",380.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",398.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1350.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1208.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",853.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",388.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",380.67,1350.9,
"Echocardiogram Transesophageal",664229,CDM,360,RC,93312,HCPCS,"OUTPATIENT ",,,1422,,,952.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",380.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1279.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",380.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",398.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1350.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1208.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",398.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",853.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",388.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",380.67,1350.9,
EEG,2695816,CDM,740,RC,95816,HCPCS,"OUTPATIENT ",,,688,,,460.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",192.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",184.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",192.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",619.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",194.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",184.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",192.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",653.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",584.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",192.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",412.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",187.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",184.18,653.6,
"Eeg Nonintracranial Surgery 95955",695955,CDM,360,RC,95955,HCPCS,"OUTPATIENT ",,,3934,,,2635.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1101.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1053.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1101.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3540.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1112.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1053.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1101.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3737.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3343.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1101.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2360.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1074.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1053.13,3737.3,
"EFMC BIOPSY BREAST STEREO SUB LT",1419082,CDM,401,RC,19082,HCPCS,"OUTPATIENT ",,,1444.3,,,967.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",404.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",386.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",404.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1299.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",408.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",386.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",404.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1372.09,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1227.66,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",404.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",866.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",394.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",386.64,1372.09,
"EFMC BIOPSY BREAST STEREO SUB RT",1419083,CDM,401,RC,19082,HCPCS,"OUTPATIENT ",,,1444.3,,,967.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",404.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",386.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",404.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1299.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",408.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",386.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",404.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1372.09,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1227.66,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",404.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",866.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",394.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",386.64,1372.09,
"EFMC US CYST ASPIR BREAST LT EA ADD",1819006,CDM,361,RC,19001,HCPCS,"OUTPATIENT ",,,340,,,227.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",95.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",91.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",95.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",306,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",96.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",91.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",95.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",323,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",289,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",95.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",204,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",91.02,323,
"EFMC US CYST ASPIR BREAST RT EA ADD",1819005,CDM,361,RC,19001,HCPCS,"OUTPATIENT ",,,340,,,227.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",95.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",91.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",95.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",306,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",96.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",91.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",95.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",323,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",289,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",95.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",204,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",91.02,323,
"EFMC US GUIDED BREAST BIOPSY ADD LT",1819084,CDM,361,RC,19084,HCPCS,"OUTPATIENT ",,,892,,,597.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",249.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",238.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",249.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",802.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,433.16,433.16,433.16,"1 through 10",other,"not separately reimbursment",252.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",238.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",249.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",847.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",758.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",249.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",535.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",243.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",238.79,847.4,
"EFMC US GUIDED BREAST BIOPSY ADD RT",1819082,CDM,360,RC,19084,HCPCS,"OUTPATIENT ",,,892,,,597.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",249.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",238.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",249.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",802.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,433.16,433.16,433.16,"1 through 10",other,"not separately reimbursment",252.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",238.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",249.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",847.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",758.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",249.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",535.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",243.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",238.79,847.4,
"EFMC US GUIDED FNA EA ADD LESION",1810006,CDM,402,RC,10006,HCPCS,"OUTPATIENT ",,,257,,,172.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",68.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",231.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",68.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",71.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",244.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",218.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",154.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",70.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",68.8,244.15,
"EGD & Colonoscopy",610018,CDM,750,RC,43235,HCPCS,"OUTPATIENT ",,,6899.75,,,4622.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1931.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1847.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1931.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",6209.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1951.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1847.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1931.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6554.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5864.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1931.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4139.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1884.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1847.06,6554.76,
"Electrocardiogram 12 Lead",2600004,CDM,730,RC,93005,HCPCS,"OUTPATIENT ",,,371.5,,,248.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",104.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",99.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",104.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",334.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",105.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",99.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",104.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",352.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",315.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",104.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",222.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",101.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",99.45,352.93,
"Electrocardiogram 12 Lead",2693005,CDM,730,RC,93005,HCPCS,"OUTPATIENT ",,,557.25,,,373.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",156.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",149.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",156.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",501.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",157.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",149.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",156.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",529.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",473.66,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",156.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",334.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",152.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",149.18,529.39,
Electroencephalogram,2695816,CDM,740,RC,95816,HCPCS,"OUTPATIENT ",,,688,,,460.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",192.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",184.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",192.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",619.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",194.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",184.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",192.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",653.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",584.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",192.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",412.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",187.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",184.18,653.6,
"Electrolyte Panel",2280051,CDM,301,RC,80051,HCPCS,"OUTPATIENT ",,,71,,,47.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",63.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",19.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",60.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.82,67.45,
"Endomysial Ab IgA LC",22164997,CDM,300,RC,86231,HCPCS,"OUTPATIENT ",,,40,,,26.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.67,38,
"Endomysial Antibody IgA LC",2256255,CDM,300,RC,86255,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,325.97,325.97,325.97,"1 through 10",other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.06,376.2,
"Enteric Pathogens Test (Verigene)",2287506,CDM,300,RC,87506,HCPCS,"OUTPATIENT ",,,263.5,,,176.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",210.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",237.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",210.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",73.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",250.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",214.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",223.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",158.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",214.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.06,250.33,
"Eosinophil Count Nasal",2289190,CDM,300,RC,89190,HCPCS,"OUTPATIENT ",,,30,,,20.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.98,28.5,
"Eosinophil Smear Body Fluid",2277205,CDM,300,RC,87205,HCPCS,"OUTPATIENT ",,,23.5,,,15.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",21.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",6.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",22.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",19.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.95,22.33,
"Eosinophils, Sputum",2277205,CDM,300,RC,87205,HCPCS,"OUTPATIENT ",,,23.5,,,15.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",21.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.71,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",6.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",22.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",19.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.95,22.33,
"Epstein-Barr DNA Quant, PCR LC",2277799,CDM,306,RC,87799,HCPCS,"OUTPATIENT ",,,487.2,,,326.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",438.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",462.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",414.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",292.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",58.88,462.84,
"Erector Spinae Block",664999,CDM,360,RC,64999,HCPCS,"OUTPATIENT ",,,850,,,569.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",227.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",765,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",227.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",238,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",807.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",722.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges",510,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",232.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",227.55,807.5,
"Erythropoietin (EPO), Serum LC",2272668,CDM,301,RC,82668,HCPCS,"OUTPATIENT ",,,168.5,,,112.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",151.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.63,160.08,
"Esophagogastroduodenoscopy (EGD)",610017,CDM,750,RC,43235,HCPCS,"OUTPATIENT ",,,4236.5,,,2838.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1186.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1134.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1186.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3812.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1198.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1134.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1186.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4024.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3601.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1186.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2541.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1156.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1134.11,4024.68,
"Esophagogastroduodenoscopy Endoscopic Ultrasound",643237,CDM,750,RC,43237,HCPCS,"OUTPATIENT ",,,810,,,542.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",216.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",729,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",216.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",226.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",769.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",688.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",226.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",486,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",221.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",216.84,769.5,
"Estradiol LC",2282670,CDM,301,RC,82670,HCPCS,"OUTPATIENT ",,,109,,,73.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",98.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",103.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",35.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",92.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",24.3,103.55,
"Estrogens, Total LC",2282672,CDM,301,RC,82672,HCPCS,"OUTPATIENT ",,,290,,,194.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",81.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",81.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",261,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",82.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",81.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",275.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",246.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",81.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",174,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",20.94,275.5,
"Eval of Oral and Pharyngeal Swallowing Fx Chg",4202440,CDM,440,RC,92610,HCPCS,"OUTPATIENT ",,,370.08,,,247.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",103.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",99.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",103.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",333.07,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",104.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",99.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",103.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",351.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",314.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",103.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",222.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",101.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",99.07,351.58,
"Eye Culture",2247070,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
"F001-IgE Egg White LC",22602452,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.62,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F002-IgE Milk LC",22602453,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.88,86.93,
"F003-IgE Codfish LC",22602456,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.88,86.93,
"F004-IgE Wheat LC",22602459,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",69.19,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F008-IgE Corn LC",22602460,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",69.19,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F010-IgE Sesame Seed LC",22602485,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",28.71,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F013-IgE Peanut LC",22602451,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F014-IgE Soybean LC",22602457,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F017-IgE Hazelnut (Filbert) LC",22602483,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F018-IgE Brazil Nut LC",22602447,CDM,300,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F018-IgE, Brazil Nut LC",22602477,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",38.62,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F020-IgE Almond LC",22602479,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F023-IgE Crab LC",22602493,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.99,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F024-IgE Shrimp LC",22602473,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.99,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F025-IgE Tomato LC",2200008,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.99,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F026-IgE Pork LC",22602498,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.67,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F027-IgE Beef LC",22602509,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F040-IgE Tuna LC",22602510,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F041-IgE Salmon LC",22602507,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F075-IgE Egg (Yolk) LC",22602487,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F080-IgE Lobster LC",22602495,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F093-IgE Chocolate/Cacao LC",22602492,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F201-IgE Pecan Nut LC",22602470,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F202-IgE Cashew Nut LC",22602461,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F207-IgE Clam LC",22602529,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F233-IgE Ovomucoid LC",22602792,CDM,300,RC,86008,HCPCS,"OUTPATIENT ",,,44,,,29.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",39.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.43,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",37.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.43,41.8,
"F256-IgE Walnut LC",22602530,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.43,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F290-IgE Oyster LC",22602514,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.43,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F338-IgE Scallop LC",22602478,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.97,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"F352-IgE Ara h 8 LC",22603839,CDM,302,RC,86008,HCPCS,"OUTPATIENT ",,,44,,,29.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",39.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",37.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,41.8,
"F422-IgE Ara h 1 LC",22603835,CDM,302,RC,86008,HCPCS,"OUTPATIENT ",,,44,,,29.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",39.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",37.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,41.8,
"F423-IgE Ara h 2 LC",22603835,CDM,302,RC,86008,HCPCS,"OUTPATIENT ",,,44,,,29.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",39.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",37.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,41.8,
"F424-IgE Ara h 3 LC",22603838,CDM,302,RC,86008,HCPCS,"OUTPATIENT ",,,44,,,29.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",39.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",37.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,41.8,
"F427-IgE Ara h 9 LC",22603840,CDM,302,RC,86008,HCPCS,"OUTPATIENT ",,,44,,,29.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",39.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.99,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",37.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.32,41.8,
"F447-IgE Ara h 6 LC",22603970,CDM,302,RC,86008,HCPCS,"OUTPATIENT ",,,44,,,29.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",39.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",37.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.4,41.8,
"Factor II, DNA Analysis LC",2230326,CDM,301,RC,81240,HCPCS,"OUTPATIENT ",,,345.12,,,231.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",96.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",96.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",310.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",96.63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",327.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",40.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",293.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",96.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",207.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.4,327.86,
"Factor IX Activity LC",2285250,CDM,305,RC,85250,HCPCS,"OUTPATIENT ",,,164,,,109.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",147.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",45.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",155.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.4,155.8,
"Factor V Leiden Mutation LC",2222722,CDM,301,RC,81241,HCPCS,"OUTPATIENT ",,,719,,,481.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",201.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",201.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",647.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",203.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",201.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",683.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",40.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",611.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",201.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",431.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.4,683.05,
"Factor VIII Activity LC",2285240,CDM,300,RC,85240,HCPCS,"OUTPATIENT ",,,129.6,,,86.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.52,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",116.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.52,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",36.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",123.12,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",22.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",110.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",77.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.4,123.12,
"FDP, Plasma LC",2285362,CDM,300,RC,85362,HCPCS,"OUTPATIENT ",,,202,,,135.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.66,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",181.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.66,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",56.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",191.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",171.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.66,191.9,
"Fecal Fat, Qualitative LC",2282705,CDM,300,RC,89125,HCPCS,"OUTPATIENT ",,,58.56,,,39.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.93,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",52.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",55.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",49.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",35.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.43,55.63,
"Fecal Occult Blood",2282271,CDM,301,RC,82270,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,36.75,36.75,36.75,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.04,46.55,
"Fecal Occult Blood (iFOB)",2282271,CDM,301,RC,82270,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.71,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,36.75,36.75,36.75,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.04,46.55,
"Fecal WBC",2289055,CDM,306,RC,89055,HCPCS,"OUTPATIENT ",,,110,,,73.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.95,104.5,
Ferritin,2282728,CDM,301,RC,82728,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.73,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,139.16,102.18,163.12,"1 through 10",other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.48,237.03,
"Ferritin, Serum LC",2282728,CDM,301,RC,82728,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.73,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.48,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,139.16,102.18,163.12,"1 through 10",other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.48,237.03,
"Fibrinogen Activity LC",2285384,CDM,305,RC,85384,HCPCS,"OUTPATIENT ",,,42,,,28.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",37.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.76,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",39.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",35.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.76,39.9,
"Fibrinogen Antigen LC",2285385,CDM,305,RC,85385,HCPCS,"OUTPATIENT ",,,33,,,22.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",29.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.76,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",31.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",28.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.76,31.35,
"Fibrinogen Level",2285384,CDM,305,RC,85384,HCPCS,"OUTPATIENT ",,,42,,,28.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",37.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.27,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",39.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",35.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.68,39.9,
"Fingers minimum of 2 Views",1473141,CDM,320,RC,73140,HCPCS,"OUTPATIENT ",,,304.5,,,204.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",81.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",274.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",81.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",289.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",258.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",182.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.44,289.28,
"First Vaccine 90471 - Admin Immunization Charge",INF90471V,CDM,771,RC,90471,HCPCS,"OUTPATIENT ",,,94.5,,,63.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",89.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",56.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.3,89.78,
"Flow Cytometry PNH LC",22502251,CDM,310,RC,88184,HCPCS,"OUTPATIENT ",,,794.31,,,532.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",714.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.15,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",224.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",46.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",222.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",754.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",47.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",675.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",476.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",47.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",22.15,754.59,
"Flu A (GXpert COVFLURSV)",2287804,CDM,306,RC,87804,HCPCS,"OUTPATIENT ",,,41,,,27.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",36.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.15,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.48,38.95,
"Flu A+B (Sofia)",2287804,CDM,306,RC,87400,HCPCS,"OUTPATIENT ",,,42.5,,,28.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",38.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,57.33,45.26,57.33,"1 through 10",other,"not separately reimbursment",12.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.9,40.38,
"Flu B (GXpert COVFLURSV)",2287804,CDM,306,RC,87804,HCPCS,"OUTPATIENT ",,,41,,,27.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",36.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.48,38.95,
"Fluoroscopic Evaluation of Swallow Function Charge",4202440,CDM,440,RC,92611,HCPCS,"OUTPATIENT ",,,621,,,416.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",166.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",558.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",166.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",173.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",589.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",527.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",372.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",169.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",166.24,589.95,
"Fluoroscopic Evaluation of Swallow Function Charge",4202440,CDM,440,RC,92611,HCPCS,"OUTPATIENT ",,,621,,,416.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",166.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",558.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",166.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",173.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",589.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",527.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",372.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",169.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",166.24,589.95,
"Folate (Folic Acid), Serum LC",2282746,CDM,301,RC,82746,HCPCS,"OUTPATIENT ",,,181.5,,,121.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.21,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",163.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",50.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",154.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",108.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.89,172.43,
"Folate LC",2282746,CDM,301,RC,82746,HCPCS,"OUTPATIENT ",,,181.5,,,121.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.21,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",163.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",44.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",50.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",154.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",108.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.49,172.43,
"Folate Level",2282746,CDM,301,RC,82746,HCPCS,"OUTPATIENT ",,,181.5,,,121.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.21,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",163.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",44.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",50.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",154.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",108.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.49,172.43,
"Folate, RBC LC",2282747,CDM,300,RC,82747,HCPCS,"OUTPATIENT ",,,171.07,,,114.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.81,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",153.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",44.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",162.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",22.22,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",145.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",102.64,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.22,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",21.78,162.52,
"Free and Total Insulin LC",2273527,CDM,301,RC,83527,HCPCS,"OUTPATIENT ",,,224.51,,,150.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",202.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.78,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",62.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",190.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.28,213.28,
"Free Insulin LC",2283527,CDM,301,RC,83527,HCPCS,"OUTPATIENT ",,,224.51,,,150.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",202.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.78,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",62.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",190.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.28,213.28,
"Free K+L Lt Chains, Quant, Serial LC",2283883,CDM,300,RC,83883,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.78,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.1,218.5,
"Free K+L Lt Chains,Qn,S LC",2283884,CDM,301,RC,83883,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.78,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.1,218.5,
"Free Kappa Lt Chains LC",2263883,CDM,301,RC,83883,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.78,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.1,218.5,
"Free Lambda Lt Chains LC",2253883,CDM,305,RC,83883,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.53,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.1,218.5,
"Free Lambda Lt Chains, S LC",2283883,CDM,300,RC,83883,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.53,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.1,218.5,
"Free T4 Level",2284439,CDM,301,RC,84439,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.65,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,195.65,88.18,226.23,12,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.65,218.5,
Frenulectomy,OR41115,CDM,360,RC,41115,HCPCS,"OUTPATIENT ",,,10000,,,6700,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677,9500,
"Fructosamine LC",2282985,CDM,301,RC,82985,HCPCS,"OUTPATIENT ",,,30.72,,,20.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.91,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",26.11,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.6,29.18,
"FSH LC",22004316,CDM,300,RC,83001,HCPCS,"OUTPATIENT ",,,211.56,,,141.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.37,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.54,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",190.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.91,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.37,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",59.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",200.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",179.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",126.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.91,200.98,
"FSH, Serum LC",2283001,CDM,301,RC,83001,HCPCS,"OUTPATIENT ",,,211.56,,,141.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.37,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.54,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",190.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.98,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.37,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",59.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",200.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",179.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",126.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.37,200.98,
"Functional residual capacity/residual volume - RT CHARGE PFT",2694240,CDM,460,RC,94727,HCPCS,"OUTPATIENT ",,,204,,,136.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",183.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",193.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",173.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.61,193.8,
"Fungus (Mycology) Culture LC",2287101,CDM,306,RC,87101,HCPCS,"OUTPATIENT ",,,96.39,,,64.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",86.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.98,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",26.99,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",91.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.88,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",81.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57.83,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.88,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.69,91.57,
"Fungus Culture With Stain LC",2287206,CDM,306,RC,87206,HCPCS,"OUTPATIENT ",,,72,,,48.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",68.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",61.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.68,68.4,
"G002-IgE Bermuda Grass LC",22602534,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.67,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"G006-IgE Timothy Grass LC",22602506,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.33,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"G008-IgE Bluegrass, Kentucky LC",22602496,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.21,86.93,
"G010-IgE Johnson Grass LC",22602503,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.21,86.93,
"G017-IgE Bahia Grass LC",22602534,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.04,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"G-6-PD, Qnt LC",2282955,CDM,300,RC,82955,HCPCS,"OUTPATIENT ",,,156.75,,,105.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",141.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.24,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",43.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",133.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",94.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.82,148.91,
"G6PD,Qn,Bld and Red Cell Count LC",2282955,CDM,300,RC,82955,HCPCS,"OUTPATIENT ",,,156.75,,,105.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",141.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.24,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",43.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",133.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",94.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.82,148.91,
"GAD-65 Autoantibody LC",2263519,CDM,301,RC,83519,HCPCS,"OUTPATIENT ",,,713,,,477.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",641.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",201.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",199.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",677.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",606.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",427.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.01,677.35,
"Gait Training Charges",4601520,CDM,420,RC,97116,HCPCS,"OUTPATIENT ",,,42.5,,,28.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",38.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",11.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",36.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.38,40.38,
"Gamma Glutamyl Transferase",2282977,CDM,301,RC,82977,HCPCS,"OUTPATIENT ",,,57,,,38.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",51.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,8.25,8.25,8.25,"1 through 10",other,"not separately reimbursment",16.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.01,54.15,
"Gangolin impar block bi-lateral",664520,CDM,370,RC,64520,HCPCS,"OUTPATIENT ",,,668,,,447.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",187.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",178.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",187.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",601.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",178.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",187.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",634.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",567.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",187.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",400.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",182.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",178.82,634.6,
"Gastric Occult Blood",2282273,CDM,301,RC,82271,HCPCS,"OUTPATIENT ",,,21.12,,,14.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.63,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",17.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.04,20.06,
"Gastrin, Serum LC",2282941,CDM,301,RC,82941,HCPCS,"OUTPATIENT ",,,90,,,60.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.63,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",22.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",76.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.63,85.5,
"General Health Panel 80050",2280050,CDM,300,RC,80050,HCPCS,"OUTPATIENT ",,,316,,,211.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",88.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",84.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",88.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",284.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",84.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",88.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",300.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",268.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",88.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",189.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",86.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",84.59,300.2,
"Genital Culture",2247070,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
"GGT LC",2282977,CDM,301,RC,82977,HCPCS,"OUTPATIENT ",,,57,,,38.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",51.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",26.63,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,8.25,8.25,8.25,"1 through 10",other,"not separately reimbursment",16.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,54.15,
"GI Profile, Stool, PCR LC",2287507,CDM,301,RC,87507,HCPCS,"OUTPATIENT ",,,655,,,438.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",183.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",333.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",183.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",589.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",185.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",333.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",183.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",622.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",340.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",556.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",183.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",393,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",340.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",25.02,622.25,
"Giardia Antigen",2287329,CDM,306,RC,87329,HCPCS,"OUTPATIENT ",,,91.4,,,61.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.34,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.08,86.83,
"Giardia lamblia Ag, EIA LC",2287329,CDM,306,RC,87329,HCPCS,"OUTPATIENT ",,,91.4,,,61.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.08,86.83,
"Glucose 2 Hour Post Prandial",2272947,CDM,301,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
"Glucose Body Fluid",2282945,CDM,301,RC,82945,HCPCS,"OUTPATIENT ",,,79.2,,,53.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",71.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",22.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",75.24,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",67.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",47.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,75.24,
"Glucose CSF",2272945,CDM,301,RC,82945,HCPCS,"OUTPATIENT ",,,79.2,,,53.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",71.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",22.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",75.24,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",67.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",47.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,75.24,
"Glucose Fasting",2282947,CDM,301,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
"Glucose LC",22001818,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
"Glucose Level",2282947G,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.93,43.7,
"Glucose Tolerance 1 Hr - 50gm",2282950,CDM,300,RC,82950,HCPCS,"OUTPATIENT ",,,72.93,,,48.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",65.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",69.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",61.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.98,69.28,
"Glucose, S LC",22001036,CDM,300,RC,82947,HCPCS,"OUTPATIENT ",,,46,,,30.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.39,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",41.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",13.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",43.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.79,43.7,
"Gluten Sensitivity Screen LC",2283516,CDM,301,RC,83516,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.79,456,
"Gram Stain Report",2287205,CDM,306,RC,87205,HCPCS,"OUTPATIENT ",,,23.5,,,15.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",21.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",6.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",22.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",19.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.95,22.33,
"Group Therapy Charge",4601800,CDM,420,RC,97150,HCPCS,"OUTPATIENT ",,,143,,,95.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",128.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",135.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",121.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.28,135.85,
"Group Therapy Provided",4411800,CDM,430,RC,97150,HCPCS,"OUTPATIENT ",,,143,,,95.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",128.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",135.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",121.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.28,135.85,
"Growth Hormone, Serum LC",2283003,CDM,301,RC,83003,HCPCS,"OUTPATIENT ",,,125,,,83.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",112.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",35,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",118.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",106.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.79,118.75,
"H pylori Breath Test LC",2283013,CDM,301,RC,83013,HCPCS,"OUTPATIENT ",,,427.5,,,286.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.53,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",92.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",384.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.53,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",119.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",406.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",67.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",363.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",256.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.79,406.13,
"H Pylori Urea Breath Test",2283013,CDM,301,RC,83013,HCPCS,"OUTPATIENT ",,,427.5,,,286.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.53,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",92.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",384.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.53,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",119.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",406.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",67.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",363.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",256.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.79,406.13,
"H. pylori Stool Ag, EIA LC",2287338,CDM,300,RC,87338,HCPCS,"OUTPATIENT ",,,409.86,,,274.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",114.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",114.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.77,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",368.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",114.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",389.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.45,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",348.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",114.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",245.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.45,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.79,389.37,
"H. pylori, IgG Abs LC",2286677,CDM,301,RC,86677,HCPCS,"OUTPATIENT ",,,82.56,,,55.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",70.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.79,78.43,
"H. pylori, IgM Ab LC",2276677,CDM,302,RC,86677,HCPCS,"OUTPATIENT ",,,82.56,,,55.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",70.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.79,78.43,
"Haptoglobin LC",2283010,CDM,301,RC,83010,HCPCS,"OUTPATIENT ",,,293.5,,,196.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",82.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",82.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.12,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",264.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,215.58,215.58,215.58,"1 through 10",other,"not separately reimbursment",83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",82.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",278.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",249.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",82.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",176.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.69,278.83,
"Haptoglobin, S LC",22001629,CDM,300,RC,83010,HCPCS,"OUTPATIENT ",,,293.5,,,196.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",82.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",82.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.12,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",264.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,215.58,215.58,215.58,"1 through 10",other,"not separately reimbursment",83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",82.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",278.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",249.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",82.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",176.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.69,278.83,
"HB Solu + Rfx Frac LC",2285660,CDM,302,RC,85660,HCPCS,"OUTPATIENT ",,,32.89,,,22.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",29.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",31.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.08,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",27.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.73,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.08,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.94,31.25,
"HBsAg Screen LC",2287340,CDM,306,RC,87340,HCPCS,"OUTPATIENT ",,,236,,,158.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",212.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.33,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",66.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",224.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",200.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",141.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.99,224.2,
"HBV Real-Time PCR, Quant LC",2287517,CDM,300,RC,87517,HCPCS,"OUTPATIENT ",,,542,,,363.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",151.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",151.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",487.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.33,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",151.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",514.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",460.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",151.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",325.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.33,514.9,
"hCG Value LC",22017377,CDM,300,RC,84702,HCPCS,"OUTPATIENT ",,,78,,,52.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.82,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",70.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",21.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",74.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",66.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.07,74.1,
"hCG, Beta Subunit, Qn (Serial) LC",2284702,CDM,301,RC,84702,HCPCS,"OUTPATIENT ",,,78,,,52.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.82,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",70.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",36.74,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",21.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",74.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",66.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.07,74.1,
"hCG,Beta Subunit Ql, S LC",2284703,CDM,301,RC,84703,HCPCS,"OUTPATIENT ",,,90,,,60.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.82,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",28.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",76.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.07,85.5,
"hCG,Beta Subunit Qnt, U LC",2284702,CDM,301,RC,84702,HCPCS,"OUTPATIENT ",,,78,,,52.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.82,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",70.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.38,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",21.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",74.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",66.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.07,74.1,
"Hct LC",2285014,CDM,305,RC,85014,HCPCS,"OUTPATIENT ",,,12.85,,,8.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.26,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",11.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",28.41,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.98,28.41,
"HCV Antibody LC",2286803,CDM,302,RC,86803,HCPCS,"OUTPATIENT ",,,323,,,216.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",290.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.29,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",90.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",306.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",274.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",193.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.29,306.85,
"HCV Antibody RFX to Quant PCR LC",2286803,CDM,302,RC,86803,HCPCS,"OUTPATIENT ",,,323,,,216.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",290.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.52,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",90.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",306.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",274.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",193.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.52,306.85,
"HCV Genotyping Non Reflex LC",2287902,CDM,306,RC,87902,HCPCS,"OUTPATIENT ",,,806.52,,,540.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",225.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",225.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",725.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.52,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",228.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",109.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",225.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",766.19,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",111.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",685.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",225.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",483.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",111.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.52,766.19,
"HCV RNA by PCR, Qn Rfx Geno LC",2287522,CDM,306,RC,87522,HCPCS,"OUTPATIENT ",,,718.45,,,481.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",646.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.8,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",203.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",201.17,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",682.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",610.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges",431.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",27.8,682.53,
"HCV RT-PCR,Quant(Non-Graph) LC",2287522,CDM,306,RC,87522,HCPCS,"OUTPATIENT ",,,718.45,,,481.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",646.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9.14,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",203.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",201.17,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",682.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",610.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",201.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges",431.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.14,682.53,
"HDL Cholesterol",2283718,CDM,301,RC,83718,HCPCS,"OUTPATIENT ",,,67,,,44.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.26,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",60.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.29,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",18.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",63.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.51,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",56.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",40.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.51,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.3,63.65,
"Helicobacter pylori IgG Antibody",2286677,CDM,301,RC,86677,HCPCS,"OUTPATIENT ",,,82.56,,,55.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.29,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",70.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.25,78.43,
"Helicobacter pylori, IgA LC",2266677,CDM,302,RC,86677,HCPCS,"OUTPATIENT ",,,82.56,,,55.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",70.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.62,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.25,78.43,
"Helper T-Lymph-CD4 LC",2286361,CDM,300,RC,86361,HCPCS,"OUTPATIENT ",,,554,,,371.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",155.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",155.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",498.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",155.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",526.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",33.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",470.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",155.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",332.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",27.77,526.3,
Hematocrit,2285014,CDM,305,RC,85014,HCPCS,"OUTPATIENT ",,,12.85,,,8.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.26,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",11.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.98,21.01,
"Hematocrit LC",2285014,CDM,305,RC,85014,HCPCS,"OUTPATIENT ",,,12.85,,,8.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.26,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",11.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.98,21.01,
"Hematopath Consult, Smear LC",2285060,CDM,305,RC,85060,HCPCS,"OUTPATIENT ",,,178.14,,,119.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",160.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",21.01,169.23,
Hemoglobin,2285018,CDM,305,RC,85018,HCPCS,"OUTPATIENT ",,,12.6,,,8.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.26,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",11.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.98,21.01,
"Hemoglobin (Hb) A1c LC",2283036,CDM,301,RC,83036,HCPCS,"OUTPATIENT ",,,154.5,,,103.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",139.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,84.39,58.61,110.17,"1 through 10",other,"not separately reimbursment",43.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",43.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",146.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",131.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",92.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9,146.78,
"Hemoglobin A1c",2283036,CDM,301,RC,83036,HCPCS,"OUTPATIENT ",,,154.5,,,103.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",139.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,84.39,58.61,110.17,"1 through 10",other,"not separately reimbursment",43.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",43.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",146.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",131.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",92.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9,146.78,
"Hemoglobin LC",2285018,CDM,305,RC,85018,HCPCS,"OUTPATIENT ",,,12.6,,,8.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.26,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",11.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.98,11.97,
"Hemoglobin POC (RE)",285018,CDM,450,RC,85018,HCPCS,"OUTPATIENT ",,,12.6,,,8.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.26,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",11.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.98,11.97,
"Hemoglobin POCT",2285018,CDM,305,RC,85018,HCPCS,"OUTPATIENT ",,,12.6,,,8.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.26,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",11.34,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.98,11.97,
"Hep A Ab, IgM LC",2286709,CDM,301,RC,86709,HCPCS,"OUTPATIENT ",,,252,,,168.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",226.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,80.69,52.96,108.42,"1 through 10",other,"not separately reimbursment",71.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",70.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",239.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",214.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",151.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.79,239.4,
"Hep A Ab, Total LC",2286708,CDM,302,RC,86708,HCPCS,"OUTPATIENT ",,,181.04,,,121.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.58,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.03,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",162.94,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.58,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",50.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",171.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",153.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",108.62,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.79,171.99,
"Hep B Core Ab, IgM LC",2286705,CDM,301,RC,86705,HCPCS,"OUTPATIENT ",,,336,,,225.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.18,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",302.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",94.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",319.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",285.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.79,319.2,
"Hep B Core Ab, Tot LC",2286704,CDM,302,RC,86704,HCPCS,"OUTPATIENT ",,,194.48,,,130.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",175.03,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",54.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",184.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",165.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",116.69,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.16,184.76,
"Hep B Surface Ab, Qual. LC",2286706,CDM,301,RC,86706,HCPCS,"OUTPATIENT ",,,168.74,,,113.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",151.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.51,160.3,
"Hep Be Ag LC",2287350,CDM,306,RC,87350,HCPCS,"OUTPATIENT ",,,118.69,,,79.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",106.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",33.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",33.23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",112.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",100.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",71.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.49,112.76,
"Hepatic Function Panel",2280076,CDM,301,RC,80076,HCPCS,"OUTPATIENT ",,,260.85,,,174.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",73.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.28,247.81,
"Hepatic Function Panel (7) LC",2280076,CDM,301,RC,80076,HCPCS,"OUTPATIENT ",,,260.85,,,174.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",73.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.28,247.81,
"Hepatitis A Antibody IgM",2286709,CDM,301,RC,86709,HCPCS,"OUTPATIENT ",,,252,,,168.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",226.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,80.69,52.96,108.42,"1 through 10",other,"not separately reimbursment",71.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",70.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",239.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",214.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",151.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.16,239.4,
"Hepatitis B Core Antibody IgM",2286705,CDM,301,RC,86705,HCPCS,"OUTPATIENT ",,,336,,,225.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.18,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",302.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.08,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",94.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",319.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",285.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.08,319.2,
"Hepatitis B Surf Ab Quant LC",2286317,CDM,301,RC,86706,HCPCS,"OUTPATIENT ",,,168.74,,,113.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",151.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.54,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.51,160.3,
"Hepatitis B Surface Antibody",2286706,CDM,301,RC,86706,HCPCS,"OUTPATIENT ",,,168.74,,,113.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",151.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.54,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.51,160.3,
"Hepatitis B Surface Antigen",2287340,CDM,306,RC,87340,HCPCS,"OUTPATIENT ",,,236,,,158.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",212.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.7,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",66.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",224.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",200.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",141.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.25,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.99,224.2,
"Hepatitis C Antibody",2286803,CDM,302,RC,86803,HCPCS,"OUTPATIENT ",,,323,,,216.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",290.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.7,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",90.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",306.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",274.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",90.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",193.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10,306.85,
"Hepatitis Panel (4) LC",2280074,CDM,301,RC,80074,HCPCS,"OUTPATIENT ",,,639.87,,,428.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.89,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",575.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",180.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.89,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",179.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",607.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",61.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",543.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",383.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,607.88,
"Hepatitis Panel, Acute",2280074,CDM,301,RC,80074,HCPCS,"OUTPATIENT ",,,639.87,,,428.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.89,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",575.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",180.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.89,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",179.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",607.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",61.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",543.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",383.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,607.88,
"Hered.Hemochromatosis, DNA LC",2281256,CDM,301,RC,81256,HCPCS,"OUTPATIENT ",,,477.12,,,319.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",133.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",133.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",429.41,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",134.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",133.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",453.26,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",40.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",405.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",133.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",286.27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.6,453.26,
"Hex Phospholipid Neut LC",22500569,CDM,300,RC,85598,HCPCS,"OUTPATIENT ",,,670,,,448.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",187.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",187.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",603,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",189.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",187.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",636.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",569.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",187.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",402,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.47,636.5,
"Hgb A1c with eAG Estimation LC",2283036,CDM,301,RC,83036,HCPCS,"OUTPATIENT ",,,154.5,,,103.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",139.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,84.39,58.61,110.17,"1 through 10",other,"not separately reimbursment",43.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",43.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",146.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",131.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",92.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.47,146.78,
"Hgb Fractionation Cascade LC",2283020,CDM,301,RC,83021,HCPCS,"OUTPATIENT ",,,118.69,,,79.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.25,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",106.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.67,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",33.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",33.23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",112.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",100.89,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",71.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.55,112.76,
"Hgb Solubility LC",2285660,CDM,302,RC,85660,HCPCS,"OUTPATIENT ",,,32.89,,,22.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",29.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.67,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",31.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.08,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",27.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.73,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.08,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.94,31.25,
"Histamine Determination, Blood LC",2283088,CDM,300,RC,83088,HCPCS,"OUTPATIENT ",,,271,,,181.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",37.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",243.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.15,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",37.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",75.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",257.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",37.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",230.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",162.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",37.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",22.15,257.45,
"HIV 1/2 Ag/Ab Combo",2286703,CDM,302,RC,86703,HCPCS,"OUTPATIENT ",,,111.5,,,74.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.85,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",100.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",31.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",105.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",94.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.96,105.93,
"HIV 1/2 Antibody Screen",2286703,CDM,302,RC,86703,HCPCS,"OUTPATIENT ",,,111.5,,,74.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.85,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",100.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.88,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",31.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",105.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",94.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.88,105.93,
"HIV Ag/Ab w/ Reflex to Conf LC",2287389,CDM,300,RC,87389,HCPCS,"OUTPATIENT ",,,176,,,117.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",158.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",167.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",27.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",149.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",105.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.16,167.2,
"HIV-1 RNA LC",2287535,CDM,300,RC,87535,HCPCS,"OUTPATIENT ",,,165,,,110.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.64,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",140.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.64,156.75,
"HIV-2 RNA LC",2287538,CDM,300,RC,87538,HCPCS,"OUTPATIENT ",,,165,,,110.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",46.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",140.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",26.97,156.75,
"HLA B 27 Disease Association LC",2281374,CDM,301,RC,81374,HCPCS,"OUTPATIENT ",,,319,,,213.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",89.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",98.4,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",89.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",287.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.91,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",98.4,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",89.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",303.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",100.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",271.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",89.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",191.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",100.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.91,303.05,
"HOLTER MONITOR 24/48 HRS INTERPRETATION",2693227,CDM,731,RC,93227,HCPCS,"OUTPATIENT ",,,103,,,69.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",92.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",97.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",87.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",61.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.57,97.85,
"Holter recording up to 48 hours - EKG Charges - RT",2693225,CDM,731,RC,93225,HCPCS,"OUTPATIENT ",,,427.1,,,286.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",119.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",114.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",119.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",384.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",114.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",119.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",405.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",363.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",119.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",256.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",116.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",114.33,405.75,
"Holter scanning analysis w/ report 12-48 hrs - EKG Charges - RT",2693226,CDM,731,RC,93226,HCPCS,"OUTPATIENT ",,,1151.6,,,771.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",322.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",308.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",322.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1036.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",325.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",308.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",322.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1094.02,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",978.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",322.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",690.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",314.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",308.28,1094.02,
"Homocyst(e)ine LC",2293090,CDM,300,RC,83090,HCPCS,"OUTPATIENT ",,,281.43,,,188.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",78.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",78.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",253.29,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.91,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",79.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",78.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",267.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",239.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",78.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",168.86,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.91,267.36,
"Hot/Cold Pack Application Charge",4411550,CDM,430,RC,97010,HCPCS,"OUTPATIENT ",,,73,,,48.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",65.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",69.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",62.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.54,69.35,
"HSV 1 and 2 IgM Abs, Indirect LC",2286696,CDM,300,RC,86696,HCPCS,"OUTPATIENT ",,,178,,,119.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",160.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.22,169.1,
"HSV 1 and 2-Spec Ab, IgG w/Rfx LC",2286695,CDM,300,RC,86695,HCPCS,"OUTPATIENT ",,,178,,,119.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.13,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",160.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.27,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.59,169.1,
"HSV 1 IgG, Type Spec LC",2286695,CDM,300,RC,86695,HCPCS,"OUTPATIENT ",,,178,,,119.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.13,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",160.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",46.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.59,169.1,
"HSV 1 IgM Abs LC",2286696,CDM,300,RC,86696,HCPCS,"OUTPATIENT ",,,178,,,119.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",160.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.16,169.1,
"HSV 1/2 PCR LC",2287529,CDM,300,RC,87529,HCPCS,"OUTPATIENT ",,,274.56,,,183.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",247.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",76.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",260.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",233.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",164.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.16,260.83,
"HSV 2 IgG, Type Spec LC",2286697,CDM,300,RC,86696,HCPCS,"OUTPATIENT ",,,178,,,119.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",160.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.93,169.1,
"HSV 2 IgM Abs LC",2286695,CDM,300,RC,86695,HCPCS,"OUTPATIENT ",,,178,,,119.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.13,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",160.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.89,169.1,
"HSV Culture and Typing LC",2287255,CDM,306,RC,87255,HCPCS,"OUTPATIENT ",,,268.13,,,179.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",241.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",75.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",254.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",38.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",227.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",160.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",38.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.89,254.72,
"HSV Culture w/o Typing LC",2287255,CDM,306,RC,87255,HCPCS,"OUTPATIENT ",,,268.13,,,179.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",241.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.78,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",75.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",254.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",38.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",227.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",160.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",38.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",20.78,254.72,
"HSV Culture with Type LC",22186057,CDM,300,RC,87255,HCPCS,"OUTPATIENT ",,,268.13,,,179.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",241.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.39,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",75.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",254.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",38.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",227.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",160.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",38.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.39,254.72,
"HSV type 1-Specific Ab, IgG LC",2286695,CDM,300,RC,86695,HCPCS,"OUTPATIENT ",,,178,,,119.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.13,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",160.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.39,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.39,169.1,
"HSV, IgM I/II Combination LC",2286694,CDM,302,RC,86694,HCPCS,"OUTPATIENT ",,,190,,,127.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",171,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.39,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",180.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",161.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.39,180.5,
"HSV-1 DNA LC",2287529,CDM,300,RC,87529,HCPCS,"OUTPATIENT ",,,274.56,,,183.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",247.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.39,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",76.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",260.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",233.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",164.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.39,260.83,
"HSV-2 DNA LC",2287529,CDM,300,RC,87529,HCPCS,"OUTPATIENT ",,,274.56,,,183.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",247.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.39,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",76.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",260.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",233.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",76.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",164.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.39,260.83,
"HSV-2 Type Spec Ab, IgG w/Rflx LC",2286696,CDM,300,RC,86696,HCPCS,"OUTPATIENT ",,,178,,,119.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",160.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.47,169.1,
"HTLV-I IB LC",2286687,CDM,300,RC,86687,HCPCS,"OUTPATIENT ",,,320,,,214.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",89.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",89.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.54,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",288,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",85.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",89.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",304,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",272,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",89.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",192,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",87.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.54,304,
"HTLV-I/II Antibodies, Qual LC",2296790,CDM,302,RC,86790,HCPCS,"OUTPATIENT ",,,107.25,,,71.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",96.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",101.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",91.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",64.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.5,101.89,
"HTLV-I/II Antibodies, Qual. LC",2296790,CDM,302,RC,86790,HCPCS,"OUTPATIENT ",,,107.25,,,71.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",96.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.86,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",101.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",91.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",64.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.86,101.89,
"HTLV-II IB LC",2286688,CDM,300,RC,86688,HCPCS,"OUTPATIENT ",,,320,,,214.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",89.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",89.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.25,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",288,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",85.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",89.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",304,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",272,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",89.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",192,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",87.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.25,304,
"Human Anti-Giardia Lamblia IgG LC",2286674,CDM,301,RC,86674,HCPCS,"OUTPATIENT ",,,135,,,90.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",121.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",128.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",114.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.1,128.25,
"I001-IgE Honeybee LC",2200518,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.1,86.93,
"I002-IgE Hornet, White Face LC",2200523,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.1,86.93,
"I003-IgE Yellow Jacket LC",2200524,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.1,86.93,
"I004-IgE Paper Wasp LC",2200521,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.1,86.93,
"I005-IgE Hornet, Yellow LC",2200520,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.1,86.93,
"I006-IgE Cockroach, German LC",22602488,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.1,86.93,
"I070-IgE Fire Ant (Invicta) LC",22602893,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"IA-2 Autoantibodies LC",2273519,CDM,302,RC,86341,HCPCS,"OUTPATIENT ",,,148.32,,,99.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.89,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",133.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.89,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",41.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",140.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",126.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.16,140.9,
ID,2287077,CDM,306,RC,87077,HCPCS,"OUTPATIENT ",,,33.5,,,22.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",30.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",9.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",31.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",28.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.38,31.83,
ID,2287077,CDM,306,RC,87077,HCPCS,"OUTPATIENT ",,,33.5,,,22.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",30.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",9.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",31.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",28.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.47,31.83,
"IgA LC",22001784,CDM,300,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.47,247.48,
"IGF-1 LC",2284305,CDM,300,RC,84305,HCPCS,"OUTPATIENT ",,,256,,,171.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.73,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",230.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.73,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",71.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",243.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",27.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",217.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",153.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.47,243.2,
"IGF-BP3 LC",22140152,CDM,301,RC,83520,HCPCS,"OUTPATIENT ",,,113.68,,,76.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",102.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",31.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",96.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.47,108,
"IgG LC",22001776,CDM,300,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.63,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.63,247.48,
"IgG, Subclass 1 LC",2282787,CDM,301,RC,82787,HCPCS,"OUTPATIENT ",,,25.92,,,17.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.03,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",23.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",22.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.23,24.62,
"IgG, Subclass 2 LC",2272787,CDM,301,RC,82787,HCPCS,"OUTPATIENT ",,,25.92,,,17.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.03,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",23.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",22.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.23,24.62,
"IgG, Subclass 3 LC",2262787,CDM,301,RC,82787,HCPCS,"OUTPATIENT ",,,25.92,,,17.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.03,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",23.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",22.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.23,24.62,
"IgG, Subclass 4 LC",2252787,CDM,301,RC,82787,HCPCS,"OUTPATIENT ",,,25.92,,,17.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.03,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",23.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.33,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",22.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.33,24.62,
"IgM LC",22001792,CDM,300,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.86,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.86,247.48,
"IGP, Rfx Cobas HPV 16/18 ASCU LC",2288175,CDM,301,RC,88175,HCPCS,"OUTPATIENT ",,,123,,,82.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.38,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",110.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.86,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",116.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",33.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",104.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.86,116.85,
"IgVH Somatic Hypermutation LC",22113639,CDM,300,RC,81263,HCPCS,"OUTPATIENT ",,,1350,,,904.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",378,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",98.4,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",378,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1215,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",381.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",98.4,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",378,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1282.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",100.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",1147.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",378,28,,,,,0,"percent of total billed charges ","28% of total billed charges",810,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",100.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",27.01,1282.5,
"Immunofixation Result, Serum: LC",22149519,CDM,300,RC,86334,HCPCS,"OUTPATIENT ",,,87,,,58.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",78.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",28.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",24.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",82.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",28.65,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",73.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",52.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.65,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",24.36,82.65,
"Immunofixation, Serum LC",2286334,CDM,300,RC,86320,HCPCS,"OUTPATIENT ",,,418.5,,,280.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.81,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",376.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",28.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",117.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",397.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",28.75,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",355.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",251.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.75,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",27.01,397.58,
"Immunofixation, Urine LC",2286335,CDM,300,RC,86335,HCPCS,"OUTPATIENT ",,,537,,,359.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",150.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",150.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",483.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.42,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",36.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",150.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",510.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",37.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",456.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",150.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",322.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",37.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.42,510.15,
"Immunoglobulin A, Qn, Serum LC",2282784,CDM,301,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",30,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.69,247.48,
"Immunoglobulin D, Quant, Serum LC",2262784,CDM,301,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",30,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.69,247.48,
"Immunoglobulin E, Total LC",2282785,CDM,301,RC,82785,HCPCS,"OUTPATIENT ",,,238,,,159.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",214.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.9,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,233.24,195.92,233.24,"1 through 10",other,"not separately reimbursment",67.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",66.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",226.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",202.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",142.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",20.71,226.1,
"Immunoglobulin E, Ttl LC",2282785,CDM,301,RC,82785,HCPCS,"OUTPATIENT ",,,238,,,159.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",214.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.72,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,233.24,195.92,233.24,"1 through 10",other,"not separately reimbursment",67.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.71,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",66.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",226.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",202.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",142.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.72,226.1,
"Immunoglobulin G, Qn, Serum LC",2292784,CDM,301,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.09,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.69,247.48,
"Immunoglobulin M, Qn, Serum LC",2272784,CDM,301,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.09,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.69,247.48,
"Immunoglobulins A/G/M, Qn, Ser LC",2252784,CDM,301,RC,82784,HCPCS,"OUTPATIENT ",,,260.5,,,174.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.16,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,218.71,207.33,226.97,"1 through 10",other,"not separately reimbursment",73.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",72.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",221.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.69,247.48,
"Incompatible - Serological Immediate Spin",2218692,CDM,302,RC,86920,HCPCS,"OUTPATIENT ",,,168,,,112.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",151.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",47.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",159.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",142.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",100.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",44.97,159.6,
"Incompatible - XM AHG Gel Interp",22286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
"Incompatible - XM AHG Tube Interp",2286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
"Infliximab and Anti-Infliximab Antibody (Serial Monitor), DoseASSURE? IFX LC",2201299,CDM,301,RC,80299,HCPCS,"OUTPATIENT ",,,401,,,268.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",360.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.04,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",112.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",340.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.14,380.95,
"Influenza A",2287400,CDM,300,RC,87400,HCPCS,"OUTPATIENT ",,,21.25,,,14.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,57.33,45.26,57.33,"1 through 10",other,"not separately reimbursment",6.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.19,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",18.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.95,20.19,
"Influenza A & B POCT",2287804,CDM,306,RC,87804,HCPCS,"OUTPATIENT ",,,41,,,27.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",36.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.31,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.48,38.95,
"Influenza A POCT",2287400A,CDM,300,RC,87400,HCPCS,"OUTPATIENT ",,,21.25,,,14.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.31,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,57.33,45.26,57.33,"1 through 10",other,"not separately reimbursment",6.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.19,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",18.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.95,20.19,
"Influenza A Resp LC",22168017,CDM,300,RC,87254,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.11,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.15,57,
"Influenza B",2277400,CDM,300,RC,87400,HCPCS,"OUTPATIENT ",,,21.25,,,14.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.11,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,57.33,45.26,57.33,"1 through 10",other,"not separately reimbursment",6.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.19,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",18.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.95,20.19,
"Influenza B POCT",2287400B,CDM,300,RC,87400,HCPCS,"OUTPATIENT ",,,21.25,,,14.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.11,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,57.33,45.26,57.33,"1 through 10",other,"not separately reimbursment",6.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.19,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",18.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.95,20.19,
"Influenza B Resp LC",22168018,CDM,300,RC,87254,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.53,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.15,57,
"Inj sacroiliac joint bilateral",627096,CDM,360,RC,27096,HCPCS,"OUTPATIENT ",,,525,,,351.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",140.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",472.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",148.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",140.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",498.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",446.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges",315,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",143.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",140.54,498.75,
"Injection epidural patch",662273,CDM,360,RC,62273,HCPCS,"OUTPATIENT ",,,706,,,473.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",189,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",635.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",189,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",670.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",600.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",423.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",189,670.7,
"Insulin Abs LC",22141600,CDM,300,RC,86337,HCPCS,"OUTPATIENT ",,,667,,,446.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",186.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",186.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",600.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",186.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",633.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",27.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",566.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",186.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",400.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.51,633.65,
"Insulin Antibodies LC",2286337,CDM,300,RC,86337,HCPCS,"OUTPATIENT ",,,667,,,446.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",186.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",186.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",600.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",21.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",186.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",633.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",27.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",566.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",186.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",400.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",21.05,633.65,
"Insulin LC",2283525,CDM,301,RC,83525,HCPCS,"OUTPATIENT ",,,173.8,,,116.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",48.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.38,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",48.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",156.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.14,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.38,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",48.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",165.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",147.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",48.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",104.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.14,165.11,
"Intrinsic Factor Abs, Serum LC",2286340,CDM,300,RC,86340,HCPCS,"OUTPATIENT ",,,102.96,,,68.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",92.66,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.14,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",28.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",97.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",87.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",61.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.14,97.81,
Intubation,2613150,CDM,410,RC,31500,HCPCS,"OUTPATIENT ",,,515.5,,,345.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",463.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",489.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138,489.73,
"Iontophoresis Charges",4411314,CDM,430,RC,97033,HCPCS,"OUTPATIENT ",,,101,,,67.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",90.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",95.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",85.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",60.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.04,95.95,
"Iontophoresis Charges",4601314,CDM,420,RC,97033,HCPCS,"OUTPATIENT ",,,101,,,67.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",90.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",95.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",85.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",60.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.04,95.95,
"Iron LC",2283540,CDM,301,RC,83540,HCPCS,"OUTPATIENT ",,,145,,,97.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",130.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.14,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",40.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",137.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",123.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.14,137.75,
"Iron Level",2283540,CDM,301,RC,83540,HCPCS,"OUTPATIENT ",,,145,,,97.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",130.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.14,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",40.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",137.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",123.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.14,137.75,
"Iron Level and TIBC",2283540,CDM,301,RC,83540,HCPCS,"OUTPATIENT ",,,177.5,,,118.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",159.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.14,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",150.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.14,168.63,
"JAK2 Mutation Analysis, Qual LC",2281270,CDM,301,RC,81270,HCPCS,"OUTPATIENT ",,,1769.8,,,1185.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1592.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.14,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",500.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",495.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1681.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",1504.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1061.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.14,1681.31,
"JAK2 Quant, Rfx CALR/E12-15/MPL LC",2281270,CDM,301,RC,81270,HCPCS,"OUTPATIENT ",,,1769.8,,,1185.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1592.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",500.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",495.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1681.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",1504.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1061.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.51,1681.31,
"JAK2 V617F Qual, Rfx E12-15 LC",2281270,CDM,301,RC,81270,HCPCS,"OUTPATIENT ",,,1769.8,,,1185.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1592.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",500.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",495.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1681.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",1504.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1061.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.51,1681.31,
"JAK2 V617F Quant Rfx CALR/MPL LC",2281270,CDM,301,RC,81270,HCPCS,"OUTPATIENT ",,,1769.8,,,1185.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1592.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",500.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",495.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1681.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",1504.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1061.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.51,1681.31,
"JAK2 V617F Rfx CALR/E12-15/MPL LC",2281270,CDM,301,RC,81270,HCPCS,"OUTPATIENT ",,,1769.8,,,1185.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1592.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",500.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",495.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1681.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",1504.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1061.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.51,1681.31,
"JAK2 V617F rfx CALR/MPL/E12-15 LC",22489555,CDM,300,RC,81270,HCPCS,"OUTPATIENT ",,,1769.8,,,1185.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1592.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",500.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",495.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1681.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",1504.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1061.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.51,1681.31,
"JAK2 V617F, Quantitative LC",2281270,CDM,301,RC,81270,HCPCS,"OUTPATIENT ",,,1769.8,,,1185.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1592.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.53,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",500.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",495.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1681.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",1504.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1061.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.53,1681.31,
"Ketones Serum",2282010,CDM,301,RC,82010,HCPCS,"OUTPATIENT ",,,190.91,,,127.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",171.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.53,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",181.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",162.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.53,181.36,
"Kidney Stone, w/ Urine/Saturation Calc LC 306266 LC",2282360,CDM,300,RC,82365,HCPCS,"OUTPATIENT ",,,40.8,,,27.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",36.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.21,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.53,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.53,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.22,38.76,
"KOH Prep (Hair, Skin, Nails)",2287220,CDM,306,RC,87220,HCPCS,"OUTPATIENT ",,,42.24,,,28.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",38.02,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",35.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.36,40.13,
"KOH Yeast",2277210,CDM,306,RC,87210,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.55,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.36,35.63,
"L. pneumophila Serogp 1 Ur Ag LC",2287449,CDM,300,RC,87449,HCPCS,"OUTPATIENT ",,,93.5,,,62.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",84.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",12.59,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",26.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",88.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",79.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",56.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.59,88.83,
"Lactate Dehydrogenase",2283615,CDM,301,RC,83615,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,38.12,37.81,38.42,"1 through 10",other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,47.5,
"Lactate Dehydrogenase Body Fluid",2273615,CDM,301,RC,83615,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,38.12,37.81,38.42,"1 through 10",other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,47.5,
"Lactate Dehydrogenase LC",2283615,CDM,301,RC,83615,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.47,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,38.12,37.81,38.42,"1 through 10",other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,47.5,
"Lactic Acid",2283605,CDM,301,RC,83605,HCPCS,"OUTPATIENT ",,,114.5,,,76.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",103.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,86.24,86.24,86.24,"1 through 10",other,"not separately reimbursment",32.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",32.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",97.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.43,108.78,
"Lactoferrin Stool",2283630,CDM,306,RC,83630,HCPCS,"OUTPATIENT ",,,84,,,56.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.98,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",75.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",79.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",71.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",50.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,79.8,
"Lamotrigine (Lamictal), Serum LC",2260299,CDM,301,RC,80175,HCPCS,"OUTPATIENT ",,,401,,,268.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",360.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",112.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",340.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,380.95,
"LD, Body Fluid LC",2273615,CDM,301,RC,83615,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,38.12,37.81,38.42,"1 through 10",other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,47.5,
"LDL Cholesterol (Direct) LC",2283721,CDM,300,RC,83721,HCPCS,"OUTPATIENT ",,,106.17,,,71.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",95.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",29.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",100.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",90.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,100.86,
"LDL Direct",2283721,CDM,300,RC,83721,HCPCS,"OUTPATIENT ",,,106.17,,,71.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",95.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",29.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",100.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",90.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,100.86,
"Lead LC",2283655,CDM,301,RC,83655,HCPCS,"OUTPATIENT ",,,27.5,,,18.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",24.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",23.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,26.13,
"Lead, Blood (Adult) LC",2283655,CDM,301,RC,83655,HCPCS,"OUTPATIENT ",,,27.5,,,18.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",24.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",23.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,26.13,
"Lead, Blood (Pediatric) LC",2263655,CDM,301,RC,83655,HCPCS,"OUTPATIENT ",,,27.5,,,18.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",24.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",23.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,26.13,
"Lead, Blood (Peds) Capillary LC",2263656,CDM,301,RC,83655,HCPCS,"OUTPATIENT ",,,27.5,,,18.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",24.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",23.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,26.13,
"Lead, Filter Paper LC",2283655,CDM,301,RC,83655,HCPCS,"OUTPATIENT ",,,27.5,,,18.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",24.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",23.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,26.13,
"Least Incompatible - XM AHG Gel Interp",22286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
"Legionella pneumophila Abs LC",2286713,CDM,300,RC,86713,HCPCS,"OUTPATIENT ",,,133,,,89.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",119.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",113.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,126.35,
"Levetiracetam (Keppra), S LC",2230299,CDM,301,RC,80177,HCPCS,"OUTPATIENT ",,,46.99,,,31.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",42.29,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",44.64,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",39.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",28.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,44.64,
"LGI1 Antibody, Cell-based IFA LC",22505575H,CDM,301,RC,86255,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,325.97,325.97,325.97,"1 through 10",other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,376.2,
"LH LC",22004290,CDM,300,RC,83002,HCPCS,"OUTPATIENT ",,,205.73,,,137.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.46,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",185.16,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",57.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",195.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",174.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",123.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,195.44,
"Lipase LC",2283690,CDM,301,RC,83690,HCPCS,"OUTPATIENT ",,,30.5,,,20.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.66,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,41.16,41.16,42.00,"1 through 10",other,"not separately reimbursment",8.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.66,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,28.98,
"Lipase Level",2283690,CDM,301,RC,83690,HCPCS,"OUTPATIENT ",,,30.5,,,20.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.66,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,41.16,41.16,42.00,"1 through 10",other,"not separately reimbursment",8.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.66,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,28.98,
"Lipid Panel LC",2280061,CDM,301,RC,80061,HCPCS,"OUTPATIENT ",,,208.5,,,139.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",187.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,101.75,15.04,166.54,14,other,"not separately reimbursment",58.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",58.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",198.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",177.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",125.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,198.08,
"Lipid Panel w/Rfx Direct LDL",2280061,CDM,301,RC,80061,HCPCS,"OUTPATIENT ",,,208.5,,,139.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",187.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,101.75,15.04,166.54,14,other,"not separately reimbursment",58.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",58.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",198.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",177.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",125.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,198.08,
"Lipid Pnl LC",2280061,CDM,301,RC,80061,HCPCS,"OUTPATIENT ",,,208.5,,,139.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",187.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,101.75,15.04,166.54,14,other,"not separately reimbursment",58.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",58.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",198.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",177.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",58.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",125.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,198.08,
"Lipoprotein (a) LC",22120188,CDM,300,RC,83695,HCPCS,"OUTPATIENT ",,,620,,,415.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",558,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",173.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",589,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",527,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",372,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,589,
"Lithium (Eskalith(R)), Serum LC",2280178,CDM,301,RC,80178,HCPCS,"OUTPATIENT ",,,36.69,,,24.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.09,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",33.02,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.27,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.27,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.01,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,34.86,
"Liver Biopsy",1847000,CDM,402,RC,47000,HCPCS,"OUTPATIENT ",,,380,,,254.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",101.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",342,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",107.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",101.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",361,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",323,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",228,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",103.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",101.73,361,
"Liver Fraction: LC",2284080,CDM,301,RC,84080,HCPCS,"OUTPATIENT ",,,251,,,168.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.33,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",225.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",70.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",238.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.96,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",213.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.96,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,238.45,
"Liver-Kidney Microsomal Ab LC",2276376,CDM,300,RC,86376,HCPCS,"OUTPATIENT ",,,190,,,127.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",171,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",180.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",161.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,180.5,
"Luteinizing Hormone(LH), S LC",2283002,CDM,301,RC,83002,HCPCS,"OUTPATIENT ",,,205.73,,,137.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.46,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",185.16,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.29,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",57.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",195.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",174.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",123.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,195.44,
"Lyme Disease Serology w/Reflex LC",22164226,CDM,302,RC,86618,HCPCS,"OUTPATIENT ",,,301.15,,,201.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",271.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",85.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",84.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",286.09,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",255.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180.69,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,286.09,
"Lyme, Total Ab Test/Reflex LC",2286618,CDM,302,RC,86618,HCPCS,"OUTPATIENT ",,,301.15,,,201.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",271.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",85.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",84.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",286.09,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",255.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180.69,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,286.09,
"Lyme, Western Blot, Serum LC",83.52,CDM,302,RC,86617,HCPCS,"OUTPATIENT ",,,83.52,,,55.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.48,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",75.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.48,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.39,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",79.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",70.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges",50.11,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,79.34,
"Lysozyme LC",22080713,CDM,300,RC,85549,HCPCS,"OUTPATIENT ",,,270,,,180.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",243,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",75.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",256.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",229.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",162,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,256.5,
"M001-IgE Penicillium chrysogen LC",22602502,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"M002-IgE Cladosporium herbarum LC",22602462,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"M003-IgE Aspergillus fumigatus LC",2266606,CDM,302,RC,86606,HCPCS,"OUTPATIENT ",,,21.6,,,14.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",6.05,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",18.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.05,20.7,
"M006-IgE Alternaria alternata LC",22602455,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"MAC ANES >5YO INITIAL 15 MIN",1299156,CDM,370,RC,99156,HCPCS,"OUTPATIENT ",,,748.9,,,501.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",209.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",209.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",674.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,367.03,367.03,367.03,"1 through 10",other,"not separately reimbursment",211.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",200.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",209.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",711.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",636.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",209.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",449.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",204.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.48,711.46,
"MAC ANES >5YO INITIAL 15 MIN",1299156,CDM,370,RC,99156,HCPCS,"OUTPATIENT ",,,748.9,,,501.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",209.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",209.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",674.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,367.03,367.03,367.03,"1 through 10",other,"not separately reimbursment",211.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",200.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",209.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",711.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",636.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",209.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",449.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",204.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.48,711.46,
"MAC ANES EA ADD 15 MIN ANY AGE",1299157,CDM,370,RC,99157,HCPCS,"OUTPATIENT ",,,260.12,,,174.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",234.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",69.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",72.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",221.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",71.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",69.63,247.11,
"MAC ANES EA ADD 15 MIN ANY AGE",1299157,CDM,370,RC,99157,HCPCS,"OUTPATIENT ",,,260.12,,,174.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",234.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",69.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",72.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",221.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",71.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",69.63,247.11,
"Magnesium LC",2283735,CDM,301,RC,83735,HCPCS,"OUTPATIENT ",,,98,,,65.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.21,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",88.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,73.99,73.99,75.05,"1 through 10",other,"not separately reimbursment",27.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",27.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",93.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",83.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",58.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,93.1,
"Magnesium Level",2283735,CDM,301,RC,83735,HCPCS,"OUTPATIENT ",,,98,,,65.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.21,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",88.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,73.99,73.99,75.05,"1 through 10",other,"not separately reimbursment",27.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",27.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",93.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",83.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",58.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,93.1,
"Manual Therapy Charge Units",4601338,CDM,420,RC,97140,HCPCS,"OUTPATIENT ",,,144,,,96.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",129.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,56.26,56.26,56.26,"1 through 10",other,"not separately reimbursment",40.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",136.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",122.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",86.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.55,136.8,
"Massage Charge Units",4601331,CDM,420,RC,97124,HCPCS,"OUTPATIENT ",,,114,,,76.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",102.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.52,108.3,
"Measles, PCR, Swab LC",22140470,CDM,300,RC,87798,HCPCS,"OUTPATIENT ",,,240,,,160.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",67.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",67.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",216,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",67.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",228,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",204,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",67.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",144,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,228,
"Mechanical Traction Charge",4601920,CDM,420,RC,97012,HCPCS,"OUTPATIENT ",,,146,,,97.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.08,138.7,
"Mercury LC",2283825,CDM,301,RC,83825,HCPCS,"OUTPATIENT ",,,72,,,48.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",68.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",61.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,68.4,
"Metanephrines, Frac, Qn, 24-Hr LC",2283835,CDM,301,RC,83835,HCPCS,"OUTPATIENT ",,,254.4,,,170.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",228.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",71.23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",241.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",216.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",152.64,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,241.68,
"Metanephrines, Frac., Pl. Free LC",2273835,CDM,301,RC,83835,HCPCS,"OUTPATIENT ",,,254.4,,,170.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",228.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",71.23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",241.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",216.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",152.64,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,241.68,
"Meter Dose Inhaler Treatment",2612011,CDM,410,RC,94640,HCPCS,"OUTPATIENT ",,,203,,,136.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",182.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",192.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",172.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.34,192.85,
"Methotrexate (MTX), Serum LC",22080299,CDM,301,RC,80299,HCPCS,"OUTPATIENT ",,,401,,,268.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",360.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",112.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",340.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,380.95,
"Methylmalonic Acid, Serum LC",2262491,CDM,301,RC,83921,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.11,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.11,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,115.43,
"MG Breast Biopsy w/ Stereo Guide Left",1419081,CDM,401,RC,19081,HCPCS,"OUTPATIENT ",,,6042.9,,,4048.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1617.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5438.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1708.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1617.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1692.01,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5740.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5136.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3625.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1650.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1617.68,5740.76,
"MG Breast Biopsy w/ Stereo Guide Left.",1419081,CDM,401,RC,19081,HCPCS,"OUTPATIENT ",,,6042.9,,,4048.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1617.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5438.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1708.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1617.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1692.01,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5740.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5136.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3625.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1650.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1617.68,5740.76,
"MG Breast Biopsy w/ Stereo Guide Right",1419084,CDM,401,RC,19081,HCPCS,"OUTPATIENT ",,,6042.9,,,4048.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1617.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5438.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1708.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1617.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1692.01,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5740.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5136.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3625.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1650.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1617.68,5740.76,
"MG Breast Biopsy w/ Stereo Guide Right.",1419084,CDM,401,RC,19081,HCPCS,"OUTPATIENT ",,,6042.9,,,4048.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1617.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5438.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1708.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1617.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1692.01,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5740.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5136.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1692.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3625.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1650.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1617.68,5740.76,
"MG Breast Tissue Specimen Surgical Left",1476098,CDM,403,RC,76098,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.77,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.39,47.5,
"MG Breast Tissue Specimen Surgical Right",1476098,CDM,403,RC,76098,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.77,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.39,47.5,
"MG Device Plcmnt w/ Mammo Guide Left",1419280,CDM,490,RC,19281,HCPCS,"OUTPATIENT ",,,826,,,553.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",231.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",221.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",231.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",743.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",233.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",221.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",231.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",784.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",702.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",231.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",495.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",225.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",221.12,784.7,
"MG Device Plcmnt w/ Mammo Guide Right",1419281,CDM,490,RC,19281,HCPCS,"OUTPATIENT ",,,826,,,553.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",231.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",221.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",231.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",743.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",233.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",221.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",231.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",784.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",702.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",231.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",495.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",225.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",221.12,784.7,
"MG Mammo Diagnostic Bilateral w/ Tomo",1470279,CDM,401,RC,77066,HCPCS,"OUTPATIENT ",,,1299.59,,,870.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",363.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",347.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",363.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1169.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,587.95,505.64,819.50,"1 through 10",other,"not separately reimbursment",367.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",347.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",363.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1234.61,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1104.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",363.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",779.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",354.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",347.9,1234.61,
"MG Mammo Diagnostic Left w/ Tomo",1470280,CDM,401,RC,77065,HCPCS,"OUTPATIENT ",,,1137.5,,,762.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",304.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1023.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,430.79,285.07,516.95,"1 through 10",other,"not separately reimbursment",321.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",304.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",318.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1080.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",966.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",682.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",310.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",304.51,1080.63,
"MG Mammo Diagnostic Right w/ Tomo",1470282,CDM,401,RC,77065,HCPCS,"OUTPATIENT ",,,1137.5,,,762.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",304.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1023.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,430.79,285.07,516.95,"1 through 10",other,"not separately reimbursment",321.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",304.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",318.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1080.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",966.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",682.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",310.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",304.51,1080.63,
"MG Mammo Digital Diagnostic Bilat",1470204,CDM,401,RC,77066,HCPCS,"OUTPATIENT ",,,1299.59,,,870.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",363.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",347.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",363.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1169.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,587.95,505.64,819.50,"1 through 10",other,"not separately reimbursment",367.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",347.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",363.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1234.61,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1104.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",363.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",779.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",354.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",347.9,1234.61,
"MG Mammo Digital Diagnostic Bilat.",1470204,CDM,401,RC,77066,HCPCS,"OUTPATIENT ",,,1101,,,737.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",308.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",294.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",308.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",990.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,587.95,505.64,819.50,"1 through 10",other,"not separately reimbursment",311.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",294.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",308.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1045.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",935.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",308.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",660.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",300.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",294.74,1045.95,
"MG Mammo Digital Diagnostic Left",1470206,CDM,401,RC,77065,HCPCS,"OUTPATIENT ",,,1137.5,,,762.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",304.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1023.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,430.79,285.07,516.95,"1 through 10",other,"not separately reimbursment",321.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",304.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",318.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1080.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",966.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",682.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",310.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",304.51,1080.63,
"MG Mammo Digital Diagnostic Left.",1470206,CDM,401,RC,77065,HCPCS,"OUTPATIENT ",,,1137.5,,,762.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",304.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1023.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,430.79,285.07,516.95,"1 through 10",other,"not separately reimbursment",321.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",304.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",318.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1080.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",966.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",682.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",310.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",304.51,1080.63,
"MG Mammo Digital Diagnostic Right",1470205,CDM,401,RC,77065,HCPCS,"OUTPATIENT ",,,1137.5,,,762.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",304.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1023.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,430.79,285.07,516.95,"1 through 10",other,"not separately reimbursment",321.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",304.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",318.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1080.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",966.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",318.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",682.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",310.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",304.51,1080.63,
"MG Mammo Screening Bilateral w/ Tomo",1477067,CDM,403,RC,77067,HCPCS,"OUTPATIENT ",,,1143.3,,,766.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",320.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",306.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",320.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1028.97,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,258.47,258.47,258.47,17,other,"not separately reimbursment",323.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",306.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",320.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1086.14,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",971.81,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",320.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",685.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",312.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",306.06,1086.14,
"MG Mammo Screening Bilateral w/ Tomo.",1477067,CDM,403,RC,77067,HCPCS,"OUTPATIENT ",,,995.5,,,666.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",278.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",266.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",278.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",895.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,258.47,258.47,258.47,17,other,"not separately reimbursment",281.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",266.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",278.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",945.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",846.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",278.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",597.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",271.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",266.5,945.73,
"MIC Urines (MicroScan)",2287186,CDM,306,RC,87186,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,29.00,29.00,29.00,"1 through 10",other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,35.63,
"Microalbumin Level 24 Hour Urine",2292043,CDM,301,RC,82043,HCPCS,"OUTPATIENT ",,,194.5,,,130.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",175.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.05,142.05,142.05,"1 through 10",other,"not separately reimbursment",55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",54.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",184.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",165.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",116.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,184.78,
"Microalbumin Level Urine",2282043,CDM,301,RC,82043,HCPCS,"OUTPATIENT ",,,194.5,,,130.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",175.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.05,142.05,142.05,"1 through 10",other,"not separately reimbursment",55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",54.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",184.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",165.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",116.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,184.78,
"Microalbumin Semiquant Ur",2282044,CDM,517,RC,82044,HCPCS,"OUTPATIENT ",,,31,,,20.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",26.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.75,29.45,
"Micropolyspora faeni IgG LC",22660100,CDM,300,RC,86609,HCPCS,"OUTPATIENT ",,,40,,,26.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,38,
"MINI C-ARM",676000,CDM,320,RC,76000,HCPCS,"OUTPATIENT ",,,1507.05,,,1009.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",421.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",403.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",421.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1356.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,103.77,88.92,162.93,"1 through 10",other,"not separately reimbursment",426.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",403.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",421.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1431.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1280.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",421.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",904.23,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",411.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.4,1431.7,
"Minimum Inhibitory Concentration",2287186,CDM,306,RC,87186,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,29.00,29.00,29.00,"1 through 10",other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,35.63,
"Mitochondrial (M2) Antibody LC",2286255,CDM,300,RC,86255,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,325.97,325.97,325.97,"1 through 10",other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,376.2,
"MODERATE SEDATION > 5 YO INITIAL 15 MIN",699152,CDM,370,RC,99152,HCPCS,"OUTPATIENT ",,,253.5,,,169.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",228.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",240.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",215.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",152.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",69.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.86,240.83,
"MODERATE SEDATION > 5 YO INITIAL 15 MIN",699152,CDM,370,RC,99152,HCPCS,"OUTPATIENT ",,,253.5,,,169.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",228.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",240.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",215.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",152.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",69.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.86,240.83,
"MODERATE SEDATION, ADD'T 15 MIN",699153,CDM,370,RC,99153,HCPCS,"OUTPATIENT ",,,88.8,,,59.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",79.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.77,84.36,
"MODERATE SEDATION, ADD'T 15 MIN",699153,CDM,370,RC,99153,HCPCS,"OUTPATIENT ",,,88.8,,,59.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",79.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",24.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",84.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",75.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",24.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",53.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",23.77,84.36,
"Mononucleosis Screen",2286308,CDM,300,RC,86308,HCPCS,"OUTPATIENT ",,,67.5,,,45.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",60.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",18.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",64.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",57.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",40.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.51,64.13,
"Mononucleosis Test, Ql LC",2286308,CDM,300,RC,86308,HCPCS,"OUTPATIENT ",,,67.5,,,45.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",60.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",18.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",64.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",57.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",40.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.51,64.13,
"MRA Abdomen w/ + w/o Contrast",5974185,CDM,619,RC,74185,HCPCS,"OUTPATIENT ",,,2460,,,1648.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",658.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",899.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2214,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",695.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",658.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",688.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2337,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2091,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1476,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",671.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",658.54,2337,
"MRA Abdomen w/o Contrast",5974185WO,CDM,619,RC,74185,HCPCS,"OUTPATIENT ",,,2460,,,1648.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",658.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",899.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2214,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",695.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",658.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",688.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2337,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2091,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",688.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1476,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",671.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",658.54,2337,
"MRA Brain/Head w/ + w/o Contrast",5970546,CDM,611,RC,70546,HCPCS,"OUTPATIENT ",,,4037,,,2704.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1130.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1080.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1130.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1329.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3633.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1141.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1080.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1130.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3835.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3431.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1130.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2422.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1102.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1080.7,3835.15,
"MRA Brain/Head w/ Contrast",6470545,CDM,611,RC,70545,HCPCS,"OUTPATIENT ",,,2661,,,1782.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",712.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",866.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2394.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",752.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",712.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",745.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2527.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2261.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1596.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",726.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",712.35,2527.95,
"MRA Brain/Head w/o Contrast",5970544,CDM,615,RC,70544,HCPCS,"OUTPATIENT ",,,2048.85,,,1372.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",573.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",548.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",573.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",880.09,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1843.97,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",579.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",548.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",573.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1946.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1741.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",573.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1229.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",559.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",548.48,1946.41,
"MRA Chest w/ + w/o Contrast",5971555,CDM,619,RC,71555,HCPCS,"OUTPATIENT ",,,2246,,,1504.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",628.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",601.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",628.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.82,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2021.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",635.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",601.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",628.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2133.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1909.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",628.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1347.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",613.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",601.25,2133.7,
"MRA Lower Extremity w/ + w/o Cnt Left",5973725,CDM,619,RC,73725,HCPCS,"OUTPATIENT ",,,1904,,,1275.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",533.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",509.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",533.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",905.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1713.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",538.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",509.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",533.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1808.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1618.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",533.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1142.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",519.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",509.7,1808.8,
"MRA Lower Extremity w/ + w/o Cnt Right",5973725,CDM,619,RC,73725,HCPCS,"OUTPATIENT ",,,1904,,,1275.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",533.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",509.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",533.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",905.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1713.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",538.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",509.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",533.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1808.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1618.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",533.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1142.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",519.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",509.7,1808.8,
"MRA Neck w/ + w/o Contrast",5970549,CDM,619,RC,70549,HCPCS,"OUTPATIENT ",,,3542,,,2373.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",991.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",948.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",991.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1331.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3187.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1001.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",948.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",991.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3364.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3010.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",991.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2125.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",967.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",948.19,3364.9,
"MRA Neck w/ Contrast",5970548,CDM,619,RC,70548,HCPCS,"OUTPATIENT ",,,3182,,,2131.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",890.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",851.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",890.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",931.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2863.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",899.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",851.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",890.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3022.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2704.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",890.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1909.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",869,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",851.82,3022.9,
"MRA Neck w/o Contrast",5970547,CDM,619,RC,70547,HCPCS,"OUTPATIENT ",,,2067,,,1384.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",578.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",553.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",578.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",881.36,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1860.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",584.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",553.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",578.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1963.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1756.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",578.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1240.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",564.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",553.34,1963.65,
"MRA Pelvis w/ + w/o Contrast",5972198,CDM,619,RC,72198,HCPCS,"OUTPATIENT ",,,2188,,,1465.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",612.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",585.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",612.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",900.37,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1969.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",618.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",585.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",612.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2078.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1859.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",612.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1312.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",597.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",585.73,2078.6,
"MRA Upper Extremity w/ + w/o Cnt Left",5973225,CDM,619,RC,73225,HCPCS,"OUTPATIENT ",,,2131,,,1427.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",596.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",570.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",596.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",913.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1917.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",602.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",570.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",596.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2024.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1811.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",596.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1278.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",581.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",570.47,2024.45,
"MRA Upper Extremity w/ + w/o Cnt Right",5973225,CDM,619,RC,73225,HCPCS,"OUTPATIENT ",,,2131,,,1427.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",596.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",570.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",596.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",913.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1917.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",602.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",570.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",596.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2024.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1811.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",596.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1278.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",581.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",570.47,2024.45,
"MRI Abdomen w/ + w/o Contrast",5974183,CDM,610,RC,74183,HCPCS,"OUTPATIENT ",,,7923.15,,,5308.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2218.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2121.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2218.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1114.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",7130.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1880.14,1880.14,1880.14,"1 through 10",other,"not separately reimbursment",2240.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2121.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2218.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7526.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6734.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2218.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4753.89,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2163.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1114.71,7526.99,
"MRI Abdomen w/ Contrast",5974182,CDM,610,RC,74182,HCPCS,"OUTPATIENT ",,,3011,,,2017.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",843.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",806.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",843.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",999,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2709.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",851.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",806.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",843.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2860.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2559.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",843.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1806.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",822.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",806.04,2860.45,
"MRI Abdomen w/o Contrast",5974181,CDM,610,RC,74181,HCPCS,"OUTPATIENT ",,,1213.65,,,813.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",339.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",324.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",339.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",725.03,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1092.29,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",343.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",324.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",339.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1152.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1031.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",339.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",728.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",331.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",324.89,1152.97,
"MRI Ankle w/ + w/o Contrast Left",5912001,CDM,610,RC,73723,HCPCS,"OUTPATIENT ",,,4843,,,3244.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1296.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4358.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1369.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1296.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1356.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4600.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4116.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2905.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1322.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.94,4600.85,
"MRI Ankle w/ + w/o Contrast Right",5912002,CDM,610,RC,73723,HCPCS,"OUTPATIENT ",,,4843,,,3244.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1296.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4358.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1369.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1296.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1356.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4600.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4116.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2905.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1322.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.94,4600.85,
"MRI Ankle w/ Contrast Left",59737221,CDM,610,RC,73722,HCPCS,"OUTPATIENT ",,,5076.5,,,3401.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1358.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4568.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1435.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1358.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1421.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4822.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4315.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3045.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1386.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.78,4822.68,
"MRI Ankle w/ Contrast Right",59737351,CDM,619,RC,73722,HCPCS,"OUTPATIENT ",,,5076.5,,,3401.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1358.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4568.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1435.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1358.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1421.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4822.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4315.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3045.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1386.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.78,4822.68,
"MRI Ankle w/o Contrast Left",5917045,CDM,610,RC,73721,HCPCS,"OUTPATIENT ",,,1044.5,,,699.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",940.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.47,89.47,89.47,"1 through 10",other,"not separately reimbursment",295.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",292.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",992.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",887.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",626.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",285.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",279.61,992.28,
"MRI Ankle w/o Contrast Right",5917005,CDM,610,RC,73721,HCPCS,"OUTPATIENT ",,,1044.5,,,699.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",940.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.47,89.47,89.47,"1 through 10",other,"not separately reimbursment",295.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",292.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",992.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",887.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",626.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",285.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",279.61,992.28,
"MRI Brachial Plexus w/ + w/o Contrast Lt",5917047,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI Brachial Plexus w/ + w/o Contrast Rt",5917038,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI Brachial Plexus w/ Contrast Lt",5904221,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI Brachial Plexus w/ Contrast Rt",5904222,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI Brachial Plexus w/o Contrast Lt",590422,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Brachial Plexus w/o Contrast Rt",5911015,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Brain w/ + w/o Contrast",5970553,CDM,611,RC,70553,HCPCS,"OUTPATIENT ",,,8389.5,,,5620.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2349.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2245.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2349.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1085.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",7550.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,857.17,273.81,1440.52,"1 through 10",other,"not separately reimbursment",2372.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2245.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2349.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7970.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7131.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2349.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5033.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2291.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1085.61,7970.03,
"MRI Brain w/ Contrast",5970552B,CDM,611,RC,70552,HCPCS,"OUTPATIENT ",,,2661,,,1782.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",712.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",925.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2394.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",752.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",712.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",745.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2527.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2261.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1596.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",726.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",712.35,2527.95,
"MRI Brain w/o Contrast",5970551,CDM,611,RC,70551,HCPCS,"OUTPATIENT ",,,3823.65,,,2561.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1070.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1023.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1070.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",827.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3441.29,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1081.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1023.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1070.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3632.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3250.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1070.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2294.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1044.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",827.47,3632.47,
"MRI Breast w/ + w/o Contrast Bilateral",5977049,CDM,614,RC,77049,HCPCS,"OUTPATIENT ",,,7650,,,5125.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2142,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2047.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2142,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",6885,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2163.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2047.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2142,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7267.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6502.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2142,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4590,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2089.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2047.91,7267.5,
"MRI Breast w/ + w/o Contrast Left",5977048L,CDM,614,RC,77048,HCPCS,"OUTPATIENT ",,,4270,,,2860.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1195.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1143.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1195.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3843,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1207.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1143.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1195.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4056.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3629.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1195.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2562,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1166.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1143.08,4056.5,
"MRI Breast w/ + w/o Contrast Right",5977048R,CDM,614,RC,77048,HCPCS,"OUTPATIENT ",,,4270,,,2860.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1195.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1143.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1195.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3843,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1207.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1143.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1195.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4056.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3629.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1195.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2562,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1166.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1143.08,4056.5,
"MRI Breast w/o Contrast Bilateral",5977047,CDM,614,RC,77047,HCPCS,"OUTPATIENT ",,,7430,,,4978.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2080.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1989.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2080.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",6687,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2101.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1989.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2080.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7058.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6315.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2080.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4458,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2029.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1989.01,7058.5,
"MRI Breast w/o Contrast Left",5977046L,CDM,614,RC,77046,HCPCS,"OUTPATIENT ",,,4010,,,2686.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1122.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1073.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1122.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3609,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1134.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1073.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1122.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3809.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3408.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1122.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2406,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1095.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1073.48,3809.5,
"MRI Breast w/o Contrast Right",5977046R,CDM,614,RC,77046,HCPCS,"OUTPATIENT ",,,4010,,,2686.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1122.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1073.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1122.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3609,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1134.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1073.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1122.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3809.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3408.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1122.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2406,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1095.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1073.48,3809.5,
"MRI Chest w/ + w/o Contrast",5971552,CDM,610,RC,71552,HCPCS,"OUTPATIENT ",,,3910,,,2619.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1094.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1046.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1094.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1277.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3519,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1105.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1046.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1094.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3714.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3323.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1094.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2346,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1067.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1046.71,3714.5,
"MRI Chest w/ Contrast",5971551,CDM,610,RC,71551,HCPCS,"OUTPATIENT ",,,3034,,,2032.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",849.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",849.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1004.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2730.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",858.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",812.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",849.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2882.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2578.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",849.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1820.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",828.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",812.2,2882.3,
"MRI Chest w/o Contrast",5971550,CDM,610,RC,71550,HCPCS,"OUTPATIENT ",,,2675,,,1792.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",749,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",716.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",749,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",902.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2407.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",756.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",716.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",749,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2541.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2273.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",749,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1605,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",730.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",716.1,2541.25,
"MRI Elbow w/ + w/o Contrast Left",59732281,CDM,610,RC,73223,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1039.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"MRI Elbow w/ + w/o Contrast Right",59732231,CDM,610,RC,73223,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1039.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"MRI Elbow w/ Contrast Left",5973222,CDM,619,RC,73222,HCPCS,"OUTPATIENT ",,,4703.69,,,3151.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4468.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.7,4468.51,
"MRI Elbow w/ Contrast Right",5973236,CDM,610,RC,73222,HCPCS,"OUTPATIENT ",,,4703.69,,,3151.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4468.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.7,4468.51,
"MRI Elbow w/o Contrast Left",5917060,CDM,614,RC,73221,HCPCS,"OUTPATIENT ",,,4905,,,3286.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1313.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4414.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1040.13,1040.13,1040.13,"1 through 10",other,"not separately reimbursment",1387.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1313.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1373.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4659.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4169.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2943,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1339.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.79,4659.75,
"MRI Elbow w/o Contrast Right",5917050,CDM,614,RC,73221,HCPCS,"OUTPATIENT ",,,4905,,,3286.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1313.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4414.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1040.13,1040.13,1040.13,"1 through 10",other,"not separately reimbursment",1387.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1313.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1373.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4659.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4169.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2943,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1339.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.79,4659.75,
"MRI Face Neck Orbit w/ + w/o Contrast",5970543,CDM,610,RC,70543,HCPCS,"OUTPATIENT ",,,2655,,,1778.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",743.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",710.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",743.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1085.32,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2389.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",750.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",710.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",743.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2522.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2256.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",743.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1593,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",725.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",710.74,2522.25,
"MRI Face Neck Orbit w/ Contrast",5970542,CDM,610,RC,70542,HCPCS,"OUTPATIENT ",,,2992,,,2004.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",837.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",837.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",883.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2692.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",846.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",800.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",837.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2842.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2543.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",837.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1795.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",817.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",800.96,2842.4,
"MRI Face Neck Orbit w/o Contrast",5970540,CDM,610,RC,70540,HCPCS,"OUTPATIENT ",,,1272,,,852.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",356.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",340.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",356.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",783.33,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1144.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",359.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",340.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",356.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1208.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1081.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",356.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",763.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",347.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",340.51,1208.4,
"MRI Femur w/ + w/o Contrast Left",5990484,CDM,610,RC,73720,HCPCS,"OUTPATIENT ",,,5874.44,,,3935.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1572.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",5287,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1661.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1572.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1644.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5580.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4993.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3524.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1604.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1108.83,5580.72,
"MRI Femur w/ + w/o Contrast Right",5900004,CDM,610,RC,73720,HCPCS,"OUTPATIENT ",,,5874.44,,,3935.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1572.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",5287,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1661.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1572.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1644.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5580.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4993.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3524.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1604.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1108.83,5580.72,
"MRI Femur w/ Contrast Left",59737271,CDM,610,RC,73719,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",907.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Femur w/ Contrast Right",59737272,CDM,610,RC,73719,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",907.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Femur w/o Contrast Left",5911014,CDM,610,RC,73718,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",798.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",798.57,3817.98,
"MRI Femur w/o Contrast Right",5917026,CDM,610,RC,73718,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",798.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",798.57,3817.98,
"MRI Foot w/ + w/o Contrast Left",5990442,CDM,610,RC,73720,HCPCS,"OUTPATIENT ",,,5874.44,,,3935.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1572.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",5287,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1661.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1572.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1644.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5580.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4993.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3524.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1604.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1108.83,5580.72,
"MRI Foot w/ + w/o Contrast Right",5993225,CDM,610,RC,73720,HCPCS,"OUTPATIENT ",,,5874.44,,,3935.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1572.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",5287,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1661.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1572.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1644.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5580.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4993.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3524.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1604.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1108.83,5580.72,
"MRI Foot w/ Contrast Left",59737273,CDM,610,RC,73719,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",907.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Foot w/ Contrast Right",59737274,CDM,610,RC,73719,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",907.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Foot w/o Contrast Left",5993306,CDM,610,RC,73718,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",798.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",798.57,3817.98,
"MRI Foot w/o Contrast Right",5990483,CDM,610,RC,73718,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",798.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",798.57,3817.98,
"MRI Forearm w/ + w/o Contrast Left",5911028,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI Forearm w/ + w/o Contrast Right",5911018,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI Forearm w/ Contrast Left",59732271,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI Forearm w/ Contrast Right",59732341,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI Forearm w/o Contrast Left",5912011,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Forearm w/o Contrast Right",5917035,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Hand w/ + w/o Contrast Left",5911019,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI Hand w/ + w/o Contrast Right",5911032,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI Hand w/ Contrast Left",59732272,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI Hand w/ Contrast Right",59732342,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI Hand w/o Contrast Left",5917036,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Hand w/o Contrast Right",5917037,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Hip w/ + w/o Contrast Left",5912003,CDM,610,RC,73723,HCPCS,"OUTPATIENT ",,,4843,,,3244.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1296.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4358.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1369.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1296.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1356.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4600.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4116.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2905.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1322.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.94,4600.85,
"MRI Hip w/ + w/o Contrast Right",5973723,CDM,610,RC,73723,HCPCS,"OUTPATIENT ",,,4843,,,3244.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1296.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4358.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1369.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1296.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1356.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4600.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4116.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2905.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1322.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.94,4600.85,
"MRI Hip w/ Contrast Left",5917019,CDM,610,RC,73722,HCPCS,"OUTPATIENT ",,,5076.5,,,3401.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1358.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4568.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1435.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1358.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1421.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4822.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4315.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3045.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1386.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.78,4822.68,
"MRI Hip w/ Contrast Right",5915011,CDM,610,RC,73722,HCPCS,"OUTPATIENT ",,,5076.5,,,3401.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1358.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4568.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1435.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1358.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1421.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4822.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4315.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3045.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1386.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.78,4822.68,
"MRI Hip w/o Contrast Left",5993226,CDM,610,RC,73721,HCPCS,"OUTPATIENT ",,,1044.5,,,699.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",940.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.47,89.47,89.47,"1 through 10",other,"not separately reimbursment",295.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",292.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",992.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",887.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",626.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",285.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",279.61,992.28,
"MRI Hip w/o Contrast Right",5916003,CDM,610,RC,73721,HCPCS,"OUTPATIENT ",,,1044.5,,,699.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",940.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.47,89.47,89.47,"1 through 10",other,"not separately reimbursment",295.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",292.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",992.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",887.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",626.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",285.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",279.61,992.28,
"MRI Humerus w/ + w/o Contrast Left",5911029,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI Humerus w/ + w/o Contrast Right",5911027,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI Humerus w/ Contrast Left",59732273,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI Humerus w/ Contrast Right",59732343,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI Humerus w/o Contrast Left",517006,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Humerus w/o Contrast Right",5917010,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Knee w/ + w/o Contrast Left",5973728,CDM,610,RC,73723,HCPCS,"OUTPATIENT ",,,4843,,,3244.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1296.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4358.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1369.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1296.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1356.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4600.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4116.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2905.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1322.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.94,4600.85,
"MRI Knee w/ + w/o Contrast Right",5973724,CDM,610,RC,73723,HCPCS,"OUTPATIENT ",,,4843,,,3244.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1296.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4358.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1369.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1296.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1356.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4600.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4116.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2905.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1322.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.94,4600.85,
"MRI Knee w/ Contrast Left",59737222,CDM,610,RC,73722,HCPCS,"OUTPATIENT ",,,5076.5,,,3401.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1358.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4568.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1435.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1358.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1421.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4822.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4315.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3045.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1386.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.78,4822.68,
"MRI Knee w/ Contrast Right",59737352,CDM,619,RC,73722,HCPCS,"OUTPATIENT ",,,5076.5,,,3401.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1358.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4568.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1435.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1358.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1421.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4822.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4315.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3045.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1386.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.78,4822.68,
"MRI Knee w/o Contrast Left",5913150,CDM,610,RC,73721,HCPCS,"OUTPATIENT ",,,1044.5,,,699.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",940.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.47,89.47,89.47,"1 through 10",other,"not separately reimbursment",295.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",292.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",992.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",887.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",626.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",285.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",279.61,992.28,
"MRI Knee w/o Contrast Right",5994240,CDM,610,RC,73721,HCPCS,"OUTPATIENT ",,,1044.5,,,699.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",940.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.47,89.47,89.47,"1 through 10",other,"not separately reimbursment",295.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",292.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",992.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",887.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",626.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",285.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",279.61,992.28,
"MRI LE Joint w/ + w/o Contrast Lt",59737241,CDM,610,RC,73723,HCPCS,"OUTPATIENT ",,,4843,,,3244.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1296.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4358.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1369.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1296.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1356.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4600.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4116.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2905.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1322.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.94,4600.85,
"MRI LE Joint w/ + w/o Contrast Rt",59737241,CDM,610,RC,73723,HCPCS,"OUTPATIENT ",,,4843,,,3244.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1296.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4358.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1369.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1296.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1356.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4600.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4116.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1356.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2905.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1322.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.94,4600.85,
"MRI LE Joint w/ Contrast Lt",59737223,CDM,610,RC,73722,HCPCS,"OUTPATIENT ",,,5076.5,,,3401.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1358.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4568.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1435.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1358.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1421.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4822.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4315.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3045.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1386.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.78,4822.68,
"MRI LE Joint w/ Contrast Rt",59737353,CDM,619,RC,73722,HCPCS,"OUTPATIENT ",,,5076.5,,,3401.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1358.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4568.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1435.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1358.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1421.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4822.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4315.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1421.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3045.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1386.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.78,4822.68,
"MRI LE Joint w/o Contrast Lt",5973721,CDM,610,RC,73721,HCPCS,"OUTPATIENT ",,,1044.5,,,699.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",940.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.47,89.47,89.47,"1 through 10",other,"not separately reimbursment",295.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",292.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",992.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",887.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",626.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",285.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",279.61,992.28,
"MRI LE Joint w/o Contrast Rt",5973732,CDM,610,RC,73721,HCPCS,"OUTPATIENT ",,,1044.5,,,699.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",940.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.47,89.47,89.47,"1 through 10",other,"not separately reimbursment",295.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",292.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",992.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",887.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",292.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",626.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",285.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",279.61,992.28,
"MRI LE Non Joint w/ + w/o Contrast Lt",5973726,CDM,610,RC,73720,HCPCS,"OUTPATIENT ",,,5874.44,,,3935.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1572.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",5287,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1661.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1572.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1644.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5580.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4993.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3524.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1604.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1108.83,5580.72,
"MRI LE Non Joint w/ + w/o Contrast Rt",5973729,CDM,610,RC,73720,HCPCS,"OUTPATIENT ",,,5874.44,,,3935.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1572.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",5287,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1661.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1572.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1644.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5580.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4993.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3524.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1604.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1108.83,5580.72,
"MRI LE Non Joint w/ Contrast Lt",59737275,CDM,610,RC,73719,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",907.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI LE Non Joint w/ Contrast Rt",59737276,CDM,610,RC,73719,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",907.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI LE Non Joint w/o Contrast Lt",5973710,CDM,610,RC,73718,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",798.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",798.57,3817.98,
"MRI LE Non Joint w/o Contrast Rt",5973718,CDM,610,RC,73718,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",798.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",798.57,3817.98,
"MRI Pelvis w/ + w/o Contrast",5972197,CDM,610,RC,72197,HCPCS,"OUTPATIENT ",,,2637,,,1766.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",738.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",705.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",738.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1110.91,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2373.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",745.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",705.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",738.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2505.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2241.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",738.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1582.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",720.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",705.92,2505.15,
"MRI Pelvis w/ Contrast",5972196,CDM,610,RC,72196,HCPCS,"OUTPATIENT ",,,3011,,,2017.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",843.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",806.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",843.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",909.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2709.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",851.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",806.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",843.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2860.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2559.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",843.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1806.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",822.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",806.04,2860.45,
"MRI Pelvis w/o Contrast",5972195,CDM,610,RC,72195,HCPCS,"OUTPATIENT ",,,4129.9,,,2767.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1156.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1105.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1156.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",817.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3716.91,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1167.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1105.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1156.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3923.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3510.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1156.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2477.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1127.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",817.84,3923.41,
"MRI Pituitary w/ + w/o Contrast",5970541P,CDM,611,RC,70553,HCPCS,"OUTPATIENT ",,,8389.5,,,5620.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2349.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2245.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2349.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1085.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",7550.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,857.17,273.81,1440.52,"1 through 10",other,"not separately reimbursment",2372.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2245.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2349.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7970.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7131.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2349.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5033.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2291.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1085.61,7970.03,
"MRI Pituitary w/ Contrast",5970552P,CDM,611,RC,70552,HCPCS,"OUTPATIENT ",,,2661,,,1782.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",712.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",925.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2394.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",752.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",712.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",745.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2527.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2261.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1596.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",726.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",712.35,2527.95,
"MRI Pituitary w/o Contrast",5970551P,CDM,611,RC,70551,HCPCS,"OUTPATIENT ",,,4248.5,,,2846.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1189.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1137.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1189.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",827.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3823.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1201.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1137.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1189.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4036.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3611.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1189.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2549.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1160.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",827.47,4036.08,
"MRI Shoulder w/ + w/o Contrast Left",59732282,CDM,610,RC,73223,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1039.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"MRI Shoulder w/ + w/o Contrast Right",59732232,CDM,610,RC,73223,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1039.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"MRI Shoulder w/ Contrast Left",5917018,CDM,619,RC,73222,HCPCS,"OUTPATIENT ",,,4703.69,,,3151.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4468.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.7,4468.51,
"MRI Shoulder w/ Contrast Right",5917000,CDM,619,RC,73222,HCPCS,"OUTPATIENT ",,,4703.69,,,3151.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4468.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.7,4468.51,
"MRI Shoulder w/o Contrast Left",5911017,CDM,614,RC,73221,HCPCS,"OUTPATIENT ",,,4905,,,3286.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1313.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4414.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1040.13,1040.13,1040.13,"1 through 10",other,"not separately reimbursment",1387.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1313.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1373.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4659.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4169.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2943,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1339.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.79,4659.75,
"MRI Shoulder w/o Contrast Right",5994060,CDM,614,RC,73221,HCPCS,"OUTPATIENT ",,,4905,,,3286.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1313.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4414.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1040.13,1040.13,1040.13,"1 through 10",other,"not separately reimbursment",1387.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1313.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1373.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4659.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4169.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2943,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1339.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.79,4659.75,
"MRI Spine Cervical w/ + w/o Contrast",5972156,CDM,612,RC,72156,HCPCS,"OUTPATIENT ",,,2850,,,1909.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",798,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",762.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",798,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1087.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2565,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",805.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",762.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",798,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2707.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2422.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",798,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1710,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",778.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",762.95,2707.5,
"MRI Spine Cervical w/ Contrast",5972142,CDM,612,RC,72142,HCPCS,"OUTPATIENT ",,,3492,,,2339.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",977.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",934.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",977.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",944.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3142.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",987.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",934.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",977.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3317.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2968.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",977.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2095.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",953.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",934.81,3317.4,
"MRI Spine Cervical w/o Contrast",5972141,CDM,612,RC,72141,HCPCS,"OUTPATIENT ",,,4680.43,,,3135.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1310.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1252.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1310.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",734.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4212.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1159.48,1159.48,1159.48,"1 through 10",other,"not separately reimbursment",1323.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1252.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1310.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4446.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3978.37,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1310.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2808.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1278.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",734.97,4446.41,
"MRI Spine Lumbar w/ + w/o Contrast",5972158,CDM,612,RC,72158,HCPCS,"OUTPATIENT ",,,2653.2,,,1777.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",742.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",710.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",742.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1063.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2387.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",750.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",710.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",742.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2520.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2255.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",742.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1591.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",724.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",710.26,2520.54,
"MRI Spine Lumbar w/ Contrast",5972149,CDM,612,RC,72149,HCPCS,"OUTPATIENT ",,,3694.13,,,2475.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1034.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",988.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1034.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",912.31,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3324.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1044.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",988.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1034.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3509.42,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",314,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1034.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2216.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1008.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",912.31,3509.42,
"MRI Spine Lumbar w/o Contrast",5972148,CDM,612,RC,72148,HCPCS,"OUTPATIENT ",,,4704.32,,,3151.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",724.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1167.02,1019.72,1777.81,"1 through 10",other,"not separately reimbursment",1330.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4469.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.67,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",724.57,4469.1,
"MRI Spine Thoracic w/ + w/o Contrast",5972157,CDM,612,RC,72157,HCPCS,"OUTPATIENT ",,,2758.08,,,1847.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",772.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",738.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",772.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1012.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2482.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",779.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",738.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",772.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2620.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2344.37,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",772.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1654.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",753.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",738.34,2620.18,
"MRI Spine Thoracic w/ Contrast",5972147,CDM,612,RC,72147,HCPCS,"OUTPATIENT ",,,3314,,,2220.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",927.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",887.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",927.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",835.81,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2982.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",937.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",887.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",927.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3148.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2816.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",927.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1988.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",905.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",835.81,3148.3,
"MRI Spine Thoracic w/o Contrast",5972146,CDM,320,RC,72146,HCPCS,"OUTPATIENT ",,,5128.5,,,3436.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1435.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1372.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1435.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",736.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4615.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1450.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1372.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1435.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4872.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4359.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1435.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3077.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1400.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",736.24,4872.08,
"MRI Tibia/Fibula w/ + w/o Contrast Left",5917020,CDM,610,RC,73720,HCPCS,"OUTPATIENT ",,,5874.44,,,3935.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1572.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",5287,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1661.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1572.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1644.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5580.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4993.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3524.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1604.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1108.83,5580.72,
"MRI Tibia/Fibula w/ + w/o Contrast Right",5916009,CDM,610,RC,73720,HCPCS,"OUTPATIENT ",,,5874.44,,,3935.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1572.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.83,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",5287,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1661.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1572.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1644.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5580.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4993.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3524.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1604.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1108.83,5580.72,
"MRI Tibia/Fibula w/ Contrast Left",59737277,CDM,610,RC,73719,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",907.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Tibia/Fibula w/ Contrast Right",5973727,CDM,610,RC,73719,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",907.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Tibia/Fibula w/o Contrast Left",5994720,CDM,610,RC,73718,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",798.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",798.57,3817.98,
"MRI Tibia/Fibula w/o Contrast Right",5917025,CDM,610,RC,73718,HCPCS,"OUTPATIENT ",,,4018.93,,,2692.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1075.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",798.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3617.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1136.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1075.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1125.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3817.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3416.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1125.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2411.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1097.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",798.57,3817.98,
"MRI TMJ",5970336,CDM,610,RC,70336,HCPCS,"OUTPATIENT ",,,2328,,,1559.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",651.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",623.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",651.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",695.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2095.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",658.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",623.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",651.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2211.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1978.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",651.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1396.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",635.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",623.21,2211.6,
"MRI UE Joint w/ + w/o Contrast Lt",59732283,CDM,610,RC,73223,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1039.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"MRI UE Joint w/ + w/o Contrast Rt",59732233,CDM,610,RC,73223,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1039.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"MRI UE Joint w/ Contrast Lt",5973222,CDM,619,RC,73222,HCPCS,"OUTPATIENT ",,,4703.69,,,3151.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4468.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.7,4468.51,
"MRI UE Joint w/ Contrast Rt",59732361,CDM,610,RC,73222,HCPCS,"OUTPATIENT ",,,4703.69,,,3151.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4468.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.7,4468.51,
"MRI UE Joint w/o Contrast Lt",5963228,CDM,614,RC,73221,HCPCS,"OUTPATIENT ",,,4905,,,3286.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1313.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4414.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1040.13,1040.13,1040.13,"1 through 10",other,"not separately reimbursment",1387.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1313.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1373.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4659.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4169.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2943,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1339.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.79,4659.75,
"MRI UE Joint w/o Contrast Rt",5973221,CDM,614,RC,73221,HCPCS,"OUTPATIENT ",,,4905,,,3286.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1313.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4414.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1040.13,1040.13,1040.13,"1 through 10",other,"not separately reimbursment",1387.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1313.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1373.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4659.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4169.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2943,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1339.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.79,4659.75,
"MRI UE Non Joint w/ + w/o Contrast Lt",5973226,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI UE Non Joint w/ + w/o Contrast Rt",5973220,CDM,610,RC,73220,HCPCS,"OUTPATIENT ",,,4520,,,3028.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1210,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1101.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4068,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1278.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1210,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1265.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4294,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3842,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1265.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2712,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1234.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1101.84,4294,
"MRI UE Non Joint w/ Contrast Lt",59732274,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI UE Non Joint w/ Contrast Rt",59732344,CDM,610,RC,73219,HCPCS,"OUTPATIENT ",,,3043,,,2038.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",814.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",892.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2738.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",860.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",814.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",852.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2890.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2586.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",852.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1825.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",831.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",814.61,2890.85,
"MRI UE Non Joint w/o Contrast Lt",5973219,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI UE Non Joint w/o Contrast Rt",5973218,CDM,610,RC,73218,HCPCS,"OUTPATIENT ",,,2630,,,1762.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.63,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2367,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",704.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",736.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2498.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2235.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",736.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1578,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",718.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",704.05,2498.5,
"MRI Wrist w/ + w/o Contrast Left",59732284,CDM,610,RC,73223,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1039.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"MRI Wrist w/ + w/o Contrast Right",59732285,CDM,610,RC,73223,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1039.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"MRI Wrist w/ Contrast Left",5990450,CDM,619,RC,73222,HCPCS,"OUTPATIENT ",,,4703.69,,,3151.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4468.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.7,4468.51,
"MRI Wrist w/ Contrast Right",5994660,CDM,619,RC,73222,HCPCS,"OUTPATIENT ",,,4703.69,,,3151.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1259.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4233.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1330.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1259.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1317.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4468.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3998.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1317.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2822.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1284.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.7,4468.51,
"MRI Wrist w/o Contrast Left",5993017,CDM,614,RC,73221,HCPCS,"OUTPATIENT ",,,4905,,,3286.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1313.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4414.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1040.13,1040.13,1040.13,"1 through 10",other,"not separately reimbursment",1387.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1313.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1373.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4659.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4169.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2943,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1339.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.79,4659.75,
"MRI Wrist w/o Contrast Right",5917014,CDM,614,RC,73221,HCPCS,"OUTPATIENT ",,,4905,,,3286.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1313.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.79,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",4414.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1040.13,1040.13,1040.13,"1 through 10",other,"not separately reimbursment",1387.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1313.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1373.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4659.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4169.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1373.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2943,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1339.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.79,4659.75,
"MRSA by NAA LC",2287641,CDM,306,RC,87641,HCPCS,"OUTPATIENT ",,,107.5,,,72.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",96.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",102.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",91.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",64.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,102.13,
"MRSA Screen (GeneXpert)",2287641,CDM,306,RC,87641,HCPCS,"OUTPATIENT ",,,107.5,,,72.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",96.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",102.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",91.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",64.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,102.13,
"MRV Brain w/ + w/o Contrast",5970546,CDM,611,RC,70546,HCPCS,"OUTPATIENT ",,,4037,,,2704.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1130.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1080.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1130.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1329.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3633.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1141.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1080.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1130.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3835.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3431.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1130.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2422.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1102.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1080.7,3835.15,
"MRV Brain w/ Contrast",5970552,CDM,611,RC,70545,HCPCS,"OUTPATIENT ",,,2661,,,1782.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",712.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",866.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2394.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",752.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",712.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",745.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2527.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2261.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",745.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1596.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",726.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",712.35,2527.95,
"MRV Brain w/o Contrast",5970544,CDM,615,RC,70544,HCPCS,"OUTPATIENT ",,,2276.5,,,1525.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",637.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",609.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",637.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",880.09,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",2048.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",643.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",609.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",637.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2162.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1935.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",637.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1365.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",621.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",609.42,2162.68,
"MTHFR LC",2281291,CDM,301,RC,81291,HCPCS,"OUTPATIENT ",,,255.97,,,171.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",230.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",71.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",243.17,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",40.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",217.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",153.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,243.17,
"Mumps Antibodies, IgG LC",2286735,CDM,302,RC,86735,HCPCS,"OUTPATIENT ",,,97.2,,,65.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",87.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",27.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",92.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",82.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",58.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,92.34,
"Mumps Antibodies, IgM LC",2286735,CDM,302,RC,86735,HCPCS,"OUTPATIENT ",,,97.2,,,65.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",87.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",27.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",92.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",82.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",58.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,92.34,
Myoglobin,2283874,CDM,301,RC,83874,HCPCS,"OUTPATIENT ",,,135.59,,,90.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.75,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",122.03,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",128.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",115.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",81.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,128.81,
"Myoglobin LC",2283874,CDM,301,RC,83874,HCPCS,"OUTPATIENT ",,,135.59,,,90.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.75,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",122.03,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",128.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",115.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",81.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,128.81,
"Myoglobin, Urine LC",2263874,CDM,301,RC,83874,HCPCS,"OUTPATIENT ",,,135.59,,,90.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.75,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",122.03,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",128.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",115.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",81.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,128.81,
Myringoplasty,OR69620,CDM,360,RC,69620,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"Myringoplasty Paper Patch",OR69610,CDM,360,RC,69610,HCPCS,"OUTPATIENT ",,,10000,,,6700,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677,9500,
Myringotomy,OR69421,CDM,360,RC,69421,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"Myringotomy with Ear Tube Insertion",OR69436,CDM,360,RC,69436,HCPCS,"OUTPATIENT ",,,10000,,,6700,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677,9500,
"Nasal Culture",2247070,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,156.28,
"Neisseria gonorrhoeae DNA -GeneXpert",2287591,CDM,301,RC,87591,HCPCS,"OUTPATIENT ",,,35,,,23.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",31.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",33.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",29.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,33.25,
"Neisseria gonorrhoeae, NAA LC",2287591,CDM,301,RC,87591,HCPCS,"OUTPATIENT ",,,35,,,23.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",31.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",33.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",29.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,33.25,
"Neuromuscular Reeducation Charges",4601700,CDM,420,RC,97112,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",41.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.56,143.93,
"Nicotine and Metabolite, Quant LC",2280310,CDM,301,RC,80307,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.65,53.65,53.65,"1 through 10",other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,179.32,
"Nicotine and Metabolite, Ur Qnt LC",2283887,CDM,301,RC,80307,HCPCS,"OUTPATIENT ",,,188.76,,,126.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",169.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.65,53.65,53.65,"1 through 10",other,"not separately reimbursment",53.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",61.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",160.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",62.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,179.32,
"Njx aa&/strd sprscap nrv bi-lateral",664485,CDM,360,RC,64418,HCPCS,"OUTPATIENT ",,,2111,,,1414.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",591.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",565.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",591.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1899.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,409.06,409.06,409.06,"1 through 10",other,"not separately reimbursment",596.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",565.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",591.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2005.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1794.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",591.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1266.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",576.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",565.11,2005.45,
"NM Cardiovascular Stress Test EO",6493015,CDM,482,RC,93015,HCPCS,"OUTPATIENT ",,,2832.5,,,1897.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",758.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2549.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1028.58,1028.58,1028.58,"1 through 10",other,"not separately reimbursment",801.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",758.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",793.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2690.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2407.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1699.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",773.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",758.26,2690.88,
"NM Myocardial SPECT Rest and Stress",1478453,CDM,341,RC,78452,HCPCS,"OUTPATIENT ",,,9773.1,,,6547.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2736.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2616.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2736.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",949.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",8795.79,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,4409.45,2700.69,4409.45,"1 through 10",other,"not separately reimbursment",2763.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2616.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2736.47,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9284.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8307.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2736.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5863.86,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2669.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",949.87,9284.45,
"NM Myocardial SPECT Rest and Stress",1478453,CDM,341,RC,78452,HCPCS,"OUTPATIENT ",,,10859,,,7275.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3040.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2906.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3040.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",949.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",9773.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,4409.45,2700.69,4409.45,"1 through 10",other,"not separately reimbursment",3070.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2906.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3040.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10316.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9230.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3040.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6515.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2965.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",949.87,10316.05,
"N-Telopeptide, Serum LC",2272523,CDM,301,RC,82523,HCPCS,"OUTPATIENT ",,,838,,,561.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",754.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",234.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",796.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",712.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",502.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,796.1,
"NT-Pro BNP",2283880,CDM,301,RC,83880,HCPCS,"OUTPATIENT ",,,232,,,155.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.66,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",208.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,174.93,174.93,174.93,"1 through 10",other,"not separately reimbursment",65.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.69,100,,43.76,43.76,43.76,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",64.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",220.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",43.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",197.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",139.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,220.4,
"NT-ProBNP II",2283880,CDM,301,RC,83880,HCPCS,"OUTPATIENT ",,,232,,,155.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.66,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",208.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,174.93,174.93,174.93,"1 through 10",other,"not separately reimbursment",65.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.69,100,,43.76,43.76,43.76,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",64.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",220.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",43.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",197.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",139.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,220.4,
"NT-proBNP LC",2283880,CDM,301,RC,83880,HCPCS,"OUTPATIENT ",,,232,,,155.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",42.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.66,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",208.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,174.93,174.93,174.93,"1 through 10",other,"not separately reimbursment",65.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",42.69,100,,43.76,43.76,43.76,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",64.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",220.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",43.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",197.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",139.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,220.4,
"O and P Status LC",22008624,CDM,300,RC,87209,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.6,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.6,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,46.55,
"O and P Status Prelim LC",2287177,CDM,300,RC,87177,HCPCS,"OUTPATIENT ",,,138.42,,,92.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",38.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",38.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",124.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",38.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",131.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.41,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",117.66,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",38.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",83.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.41,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,131.5,
"O+P Exam, Formalin Only LC",2287177,CDM,300,RC,87177,HCPCS,"OUTPATIENT ",,,138.42,,,92.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",38.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",38.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",124.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",38.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",131.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.41,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",117.66,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",38.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",83.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.41,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.83,131.5,
"Occult Blood Diagnostic 1st Spec",2282270,CDM,301,RC,82270,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,36.75,36.75,36.75,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.04,46.55,
"Occult Blood Screen",2282271,CDM,301,RC,82270,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,36.75,36.75,36.75,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.04,46.55,
"Occult Blood Screen 1",2282271,CDM,301,RC,82270,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.42,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,36.75,36.75,36.75,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.04,46.55,
"Occult Blood Screen 2",2210050,CDM,300,RC,82270,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.42,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,36.75,36.75,36.75,"1 through 10",other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.04,46.55,
"Occult Blood Screen 3",2210055,CDM,300,RC,82272,HCPCS,"OUTPATIENT ",,,26,,,17.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",23.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.42,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.04,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",22.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.04,24.7,
"Organic Acids, Urine, Quant LC",2283920,CDM,301,RC,83918,HCPCS,"OUTPATIENT ",,,272,,,182.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",76.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",76.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",244.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.42,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",76.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",258.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.11,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",231.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",76.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",163.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.11,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.42,258.4,
"Orthotic Mgmt and Training Charges",4404720,CDM,430,RC,97760,HCPCS,"OUTPATIENT ",,,150,,,100.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",135,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",142.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",127.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.16,142.5,
"Orthotic Mgmt and Training Charges",4604720,CDM,420,RC,97760,HCPCS,"OUTPATIENT ",,,150,,,100.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",135,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",142.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",127.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.16,142.5,
"Osmolality Serum",2283930,CDM,301,RC,83930,HCPCS,"OUTPATIENT ",,,79,,,52.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.09,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",71.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.42,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,63.54,63.54,63.54,"1 through 10",other,"not separately reimbursment",22.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",22.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",75.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",67.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",47.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.32,75.05,
"Osmolality Urine",2283935,CDM,301,RC,83935,HCPCS,"OUTPATIENT ",,,39.5,,,26.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.37,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",35.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.42,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",37.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",33.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",23.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.57,37.53,
"Osmolality, Urine LC",22003442,CDM,300,RC,83935,HCPCS,"OUTPATIENT ",,,39.5,,,26.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.37,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",35.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.42,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",37.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",33.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",23.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.57,37.53,
"OT ADL Training Assist Units",4497535,CDM,430,RC,97535,HCPCS,"OUTPATIENT ",,,91,,,60.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",77.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.36,86.45,
"OT Cog Ther Intervent, First 15 Min Time",4414340,CDM,430,RC,97129,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.39,47.5,
"OT Group Therapy Units",4411800,CDM,430,RC,97150,HCPCS,"OUTPATIENT ",,,143,,,95.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",128.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",135.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",121.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.28,135.85,
"OT High Complex Units",4497167,CDM,434,RC,97167,HCPCS,"OUTPATIENT ",,,336,,,225.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",89.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",302.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",89.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",319.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",285.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",91.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",89.95,319.2,
"OT Low Complex Units",4497165,CDM,434,RC,97165,HCPCS,"OUTPATIENT ",,,180,,,120.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",162,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",171,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",153,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",108,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.19,171,
"OT Lymphedema Wrap below knee",44295819,CDM,430,RC,29581,HCPCS,"OUTPATIENT ",,,214,,,143.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",192.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",57.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",203.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",181.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",128.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.29,203.3,
"OT Lymphedema Wrap Upper Arm",4429584,CDM,430,RC,29584,HCPCS,"OUTPATIENT ",,,214,,,143.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",192.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",57.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",203.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",181.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",128.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.29,203.3,
"OT Lymphedema Wrap Upper Arm Assist",4429584,CDM,430,RC,29584,HCPCS,"OUTPATIENT ",,,214,,,143.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",192.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",57.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",203.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",181.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",128.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.29,203.3,
"OT Manual Therapy Assistant Units",4411338,CDM,430,RC,97140,HCPCS,"OUTPATIENT ",,,144,,,96.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",129.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,56.26,56.26,56.26,"1 through 10",other,"not separately reimbursment",40.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",136.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",122.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",86.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.55,136.8,
"OT Manual Therapy Charge Units",4411338,CDM,430,RC,97140,HCPCS,"OUTPATIENT ",,,144,,,96.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",129.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,56.26,56.26,56.26,"1 through 10",other,"not separately reimbursment",40.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",136.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",122.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",86.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.55,136.8,
"OT Massage Charge Units",4411331,CDM,430,RC,97124,HCPCS,"OUTPATIENT ",,,114,,,76.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",102.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.52,108.3,
"OT Moderate Complex Units",4497166,CDM,434,RC,97166,HCPCS,"OUTPATIENT ",,,450,,,301.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",120.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",405,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",127.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",120.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",427.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",382.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126,28,,,,,0,"percent of total billed charges ","28% of total billed charges",270,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",120.47,427.5,
"OT Neuromuscular Reeducation Assist Unit",4411700,CDM,430,RC,97112,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",41.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.56,143.93,
"OT Neuromuscular Reeducation Charges",4411700,CDM,430,RC,97112,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",41.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.56,143.93,
"OT Orthotic Mgmt/Train Establish Charge",4411012,CDM,430,RC,97763,HCPCS,"OUTPATIENT ",,,255,,,170.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",68.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",229.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",68.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",71.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",242.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",216.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",153,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",69.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",68.26,242.25,
"OT Paraffin Bath Charge",4411735,CDM,430,RC,97018,HCPCS,"OUTPATIENT ",,,79,,,52.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",71.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",22.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",75.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",67.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",47.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",21.15,75.05,
"OT Paraffin Bath Units",4411735,CDM,430,RC,97018,HCPCS,"OUTPATIENT ",,,79,,,52.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",71.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",22.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",75.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",67.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",47.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",21.15,75.05,
"OT Physical Performance Test Charges",4401113,CDM,430,RC,97750,HCPCS,"OUTPATIENT ",,,134,,,89.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",120.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",127.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",113.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",80.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.87,127.3,
"OT Prosthetic Training Charges",4401790,CDM,430,RC,97761,HCPCS,"OUTPATIENT ",,,101,,,67.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",90.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",95.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",85.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",60.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.04,95.95,
"OT ReEval Units",4497168,CDM,430,RC,97168,HCPCS,"OUTPATIENT ",,,218,,,146.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",61.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",61.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",196.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",61.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",58.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",61.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",207.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",185.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",61.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",130.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",59.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",58.36,207.1,
"OT Therapeutic Activities Assistant Units",4411045,CDM,430,RC,97530,HCPCS,"OUTPATIENT ",,,90.5,,,60.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",76.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.23,85.98,
"OT Therapeutic Activities Charges",4411045,CDM,430,RC,97530,HCPCS,"OUTPATIENT ",,,90.5,,,60.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",76.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.23,85.98,
"OT Therapeutic Exercise Assistant units",4411900,CDM,430,RC,97110,HCPCS,"OUTPATIENT ",,,125.5,,,84.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,141.96,68.01,413.78,"1 through 10",other,"not separately reimbursment",35.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.6,119.23,
"OT Therapeutic Exercise Charges",4411900,CDM,430,RC,97110,HCPCS,"OUTPATIENT ",,,125.5,,,84.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,141.96,68.01,413.78,"1 through 10",other,"not separately reimbursment",35.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.6,119.23,
"OT Unattended E-stim Assistant Units",4411890,CDM,430,RC,97014,HCPCS,"OUTPATIENT ",,,146,,,97.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.08,138.7,
"Other Thermal Charge",4601550,CDM,420,RC,97010,HCPCS,"OUTPATIENT ",,,73,,,48.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",65.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",69.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",62.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.54,69.35,
"Ova + Parasite Status LC",2287209,CDM,306,RC,87209,HCPCS,"OUTPATIENT ",,,49,,,32.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.6,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",24.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.6,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.72,46.55,
"Oxcarbazepine (Trileptal),S LC",2220299,CDM,300,RC,80299,HCPCS,"OUTPATIENT ",,,401,,,268.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",360.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",46.8,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",112.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",340.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.14,380.95,
"Oxidized LDL LC",2283721,CDM,300,RC,83721,HCPCS,"OUTPATIENT ",,,106.17,,,71.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",95.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",29.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",100.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",90.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",63.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.77,100.86,
"Pancreatic Elastase, Fecal LC",2282656,CDM,301,RC,82656,HCPCS,"OUTPATIENT ",,,115,,,77.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",103.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",32.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",109.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",97.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",69,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.69,109.25,
"Pap IG Aptima HPV LC",2288175,CDM,301,RC,88175,HCPCS,"OUTPATIENT ",,,123,,,82.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.38,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",110.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",116.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",33.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",104.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",73.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.77,116.85,
"Pap Lb (Liquid-based) LC",2278142,CDM,311,RC,88142,HCPCS,"OUTPATIENT ",,,120.12,,,80.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.48,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.85,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",108.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",33.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.48,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",33.63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",114.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.99,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",102.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.99,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.93,114.11,
"Parainfluenza 1 Resp LC",22168021,CDM,300,RC,87254,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.27,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.15,57,
"Parainfluenza 2 Resp LC",22168020,CDM,300,RC,87254,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.27,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.15,57,
"Parainfluenza 3 Resp LC",22168021,CDM,300,RC,87254,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",33.27,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.15,57,
"Partial Thromboplastin Time",2285730,CDM,305,RC,85730,HCPCS,"OUTPATIENT ",,,85,,,56.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.54,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.25,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",76.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.55,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,64.19,64.19,64.71,"1 through 10",other,"not separately reimbursment",24.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.54,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",80.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.69,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",72.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.69,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.54,80.75,
"Parvovirus B19 PCR LC",2287798,CDM,306,RC,87798,HCPCS,"OUTPATIENT ",,,1137,,,761.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",318.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",318.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1023.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.7,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",321.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",318.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1080.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",966.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",318.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",682.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.16,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.7,1080.15,
"Path Smear Review TC",SEPA85060,CDM,310,RC,85060,HCPCS,"OUTPATIENT ",,,178.14,,,119.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",160.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.7,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.7,169.23,
"PCA Type-1 (Anti-Yo) Ab LC",22505575I,CDM,301,RC,86255,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.7,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,325.97,325.97,325.97,"1 through 10",other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.16,376.2,
"PE (S) PDF LC",22001498,CDM,300,RC,84165,HCPCS,"OUTPATIENT ",,,188,,,125.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",169.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.7,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,34.99,34.99,34.99,"1 through 10",other,"not separately reimbursment",53.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",178.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",159.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.51,178.6,
"Peripherally Inserted Central Catheter Insertion",4036569,CDM,361,RC,36569,HCPCS,"OUTPATIENT ",,,1436.16,,,962.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",384.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1292.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",406.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",384.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",402.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1364.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1220.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",861.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",392.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",384.46,1364.35,
"Peripherally Inserted Central Catheter Insertion",4036569,CDM,361,RC,36569,HCPCS,"OUTPATIENT ",,,1436.16,,,962.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",384.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1292.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",406.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",384.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",402.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1364.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1220.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",402.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",861.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",392.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",384.46,1364.35,
"PET CT Skull Base to Midthigh",1478815,CDM,404,RC,78815,HCPCS,"OUTPATIENT ",,,14936.5,,,10007.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4182.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3998.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4182.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13442.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,4062.59,3169.97,4955.21,"1 through 10",other,"not separately reimbursment",4224.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3998.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4182.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14189.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12696.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4182.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8961.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4079.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3998.5,14189.68,
"PET CT Whole Body",1478816,CDM,404,RC,78816,HCPCS,"OUTPATIENT ",,,9046.18,,,6060.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2532.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2421.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2532.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",8141.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2558.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2421.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2532.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8593.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7689.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2532.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5427.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2470.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2421.66,8593.87,
"pH, Body Fluid LC.",2283986,CDM,300,RC,83986,HCPCS,"OUTPATIENT ",,,81,,,54.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.92,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",72.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.7,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",22.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",76.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",68.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",48.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.5,76.95,
"Phenobarbital, S LC",2280184,CDM,301,RC,80184,HCPCS,"OUTPATIENT ",,,61.92,,,41.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.74,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",55.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.7,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",52.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.15,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.41,58.82,
"Phenobarbital, Serum LC",2280184,CDM,301,RC,80184,HCPCS,"OUTPATIENT ",,,61.92,,,41.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.74,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",55.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",26.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",52.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.15,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.41,58.82,
"Phenotype (PI) LC",2282104,CDM,300,RC,82104,HCPCS,"OUTPATIENT ",,,130.85,,,87.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",117.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",36.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",124.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",111.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.93,124.31,
"Phenytoin (Dilantin), Serum LC",2280185,CDM,301,RC,80185,HCPCS,"OUTPATIENT ",,,48.48,,,32.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",43.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.57,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.09,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.06,46.06,
"Phenytoin Level Total",2280185,CDM,301,RC,80185,HCPCS,"OUTPATIENT ",,,48.48,,,32.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",43.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.45,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.57,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",41.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.09,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.57,46.06,
"Phospholipids, Serum LC",2284311,CDM,301,RC,84311,HCPCS,"OUTPATIENT ",,,29,,,19.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",26.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.45,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",24.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.12,27.55,
"Phosphorus LC",2284100,CDM,301,RC,84100,HCPCS,"OUTPATIENT ",,,14,,,9.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.52,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",12.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.45,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,13.72,13.18,13.72,"1 through 10",other,"not separately reimbursment",3.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",11.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.92,23.45,
"Phosphorus Level",2284100,CDM,301,RC,84100,HCPCS,"OUTPATIENT ",,,14,,,9.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.52,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",12.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.45,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,13.72,13.18,13.72,"1 through 10",other,"not separately reimbursment",3.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",11.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.92,23.45,
"Pigeon Serum IgG LC",22660076,CDM,300,RC,86331,HCPCS,"OUTPATIENT ",,,541.6,,,362.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",151.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",151.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",487.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",151.65,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",514.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",460.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",151.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges",324.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.08,514.52,
"Pinworm Exam",2287172,CDM,300,RC,87172,HCPCS,"OUTPATIENT ",,,36,,,24.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",32.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",30.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.36,34.2,
"Platelet Antibody Profile LC",2286022,CDM,300,RC,86022,HCPCS,"OUTPATIENT ",,,244,,,163.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.25,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",219.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",68.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",231.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.55,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",207.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",146.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.55,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.77,231.8,
"Platelet Count",2285049,CDM,305,RC,85049,HCPCS,"OUTPATIENT ",,,21.12,,,14.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",17.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.63,20.06,
"Platelet Count LC",2285049,CDM,305,RC,85049,HCPCS,"OUTPATIENT ",,,21.12,,,14.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.06,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",17.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.63,20.06,
"Plt Neutralization LC",22500049,CDM,300,RC,85597,HCPCS,"OUTPATIENT ",,,1090,,,730.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",305.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",305.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",981,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",308.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",305.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1035.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",926.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",305.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",654,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.77,1035.5,
"Pneumo Ab Type 17 (17F) LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.09,104.72,
"Pneumo Ab Type 2 LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.09,104.72,
"Pneumo Ab Type 20 LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9.59,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.59,104.72,
"Pneumo Ab Type 22 (22F) LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9.59,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.59,104.72,
"Pneumo Ab Type 34 (10A) LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.09,104.72,
"Pneumo Ab Type 43 (11A) LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.09,104.72,
"Pneumo Ab Type 5 LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.09,104.72,
"Pneumo Ab Type 54 (15B) LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.09,104.72,
"Pneumo Ab Type 70 (33F) LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.09,104.72,
"Pneumococcal Ab (23 Serotype) LC",2286609,CDM,302,RC,86317,HCPCS,"OUTPATIENT ",,,110.23,,,73.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.09,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.77,104.72,
"POET Exam",OMPOET,CDM,500,RC,97750,HCPCS,"OUTPATIENT ",,,110,,,73.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.45,104.5,
"Porphobilinogen (PBG), Quantitative, Random Urine LC",2284110,CDM,301,RC,84110,HCPCS,"OUTPATIENT ",,,150.15,,,100.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.62,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",135.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.62,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",142.64,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",127.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.09,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.77,142.64,
"Porphyrins, Qn, 24 Hr Ur. LC",2274120,CDM,301,RC,84120,HCPCS,"OUTPATIENT ",,,287,,,192.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",80.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",80.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",258.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",27.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",80.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",272.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",243.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",80.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",172.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.5,272.65,
"Porphyrins, Quantitative, Random Urine LC",2284120,CDM,300,RC,84120,HCPCS,"OUTPATIENT ",,,287,,,192.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",80.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",80.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",258.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",80.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",272.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",243.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",80.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",172.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.69,272.65,
"Potassium LC",22001180,CDM,300,RC,84132,HCPCS,"OUTPATIENT ",,,35,,,23.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.32,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",31.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,7.67,7.67,7.67,"1 through 10",other,"not separately reimbursment",9.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",33.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",29.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.78,33.25,
"Potassium Level",2284132,CDM,301,RC,84132,HCPCS,"OUTPATIENT ",,,35,,,23.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.32,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",31.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,7.67,7.67,7.67,"1 through 10",other,"not separately reimbursment",9.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",33.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",29.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.78,33.25,
"Potassium Level 24 Hour Urine",2294133,CDM,301,RC,84133,HCPCS,"OUTPATIENT ",,,57,,,38.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.91,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",51.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.41,54.15,
"Potassium Level Urine",2284133,CDM,301,RC,84133,HCPCS,"OUTPATIENT ",,,57,,,38.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.91,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",51.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.41,54.15,
Prealbumin,2284134,CDM,301,RC,84134,HCPCS,"OUTPATIENT ",,,96,,,64.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.05,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",86.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",26.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",91.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.71,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",81.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.71,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.69,91.2,
"Pregnancy Test Serum Qual",2284703,CDM,301,RC,84703,HCPCS,"OUTPATIENT ",,,90,,,60.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.82,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.07,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",76.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.07,85.5,
"Pregnancy Test Urine Qual",2281025,CDM,307,RC,81025,HCPCS,"OUTPATIENT ",,,31,,,20.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",26.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.96,29.45,
"Pregnancy Test, Urine LC",2281025,CDM,307,RC,81025,HCPCS,"OUTPATIENT ",,,31,,,20.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",26.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.96,29.45,
"Primidone (Mysoline(R)), Serum LC",2280188,CDM,301,RC,80188,HCPCS,"OUTPATIENT ",,,64,,,42.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.86,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.81,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",57.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.86,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",60.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",54.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",38.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.69,60.8,
Procalcitonin,2284145,CDM,301,RC,84145,HCPCS,"OUTPATIENT ",,,96,,,64.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.06,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.82,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",86.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.06,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",26.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",91.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",81.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.69,91.2,
"Progesterone LC",2284144,CDM,301,RC,84144,HCPCS,"OUTPATIENT ",,,211,,,141.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",189.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",29.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",59.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",200.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",179.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",126.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",25.61,200.45,
"Proinsulin LC",2284206,CDM,301,RC,84206,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.4,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.4,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",22.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,218.5,
"Prolactin LC",2284146,CDM,301,RC,84146,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.37,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",29.21,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.37,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",24.37,156.28,
"Prostate Specific Ag LC",2284154,CDM,300,RC,84154,HCPCS,"OUTPATIENT ",,,224,,,150.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",201.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",38.38,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",62.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",212.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",190.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.13,212.8,
"Prostate-Specific Ag LC",2284153,CDM,301,RC,84153,HCPCS,"OUTPATIENT ",,,43.5,,,29.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",39.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.93,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.18,41.33,
"Prosthetic Training Charges",4601790,CDM,420,RC,97761,HCPCS,"OUTPATIENT ",,,101,,,67.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",90.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",95.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",85.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",60.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.04,95.95,
"Prot,U24 Calculated LC",2294156,CDM,301,RC,84156,HCPCS,"OUTPATIENT ",,,71.5,,,47.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",28.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.90,53.90,53.90,"1 through 10",other,"not separately reimbursment",20.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",60.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,67.93,
"Protein Body Fluid",2284157,CDM,301,RC,84157,HCPCS,"OUTPATIENT ",,,76.32,,,51.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",68.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",28.01,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",21.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",72.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",64.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",45.79,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,72.5,
"Protein C Activity (Chromogenic) LC",2285303,CDM,300,RC,85303,HCPCS,"OUTPATIENT ",,,161.76,,,108.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",145.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.71,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",45.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",153.67,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",137.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",97.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.39,153.67,
"Protein C Antigen LC",2285302,CDM,300,RC,85302,HCPCS,"OUTPATIENT ",,,151.2,,,101.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.52,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",136.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.64,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",128.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.12,143.64,
"Protein Cerebrospinal Fluid",2274157,CDM,301,RC,84157,HCPCS,"OUTPATIENT ",,,76.32,,,51.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",68.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.89,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",21.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",72.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",64.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",45.79,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,72.5,
"Protein C-Functional LC",2285303,CDM,300,RC,85303,HCPCS,"OUTPATIENT ",,,161.76,,,108.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.01,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",145.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",61.45,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",45.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",153.67,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",137.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",97.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.39,153.67,
"Protein Electro, 24-Hour Urine LC",2274166,CDM,301,RC,84166,HCPCS,"OUTPATIENT ",,,142.56,,,95.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.52,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",128.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",34.13,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",39.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",135.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",22.88,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",121.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.88,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",22.43,135.43,
"Protein Electro, Random Urine LC",2284166,CDM,301,RC,84166,HCPCS,"OUTPATIENT ",,,142.56,,,95.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",39.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",39.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.52,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",128.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.03,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",39.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",135.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",22.88,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",121.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",39.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",85.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.88,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",19.03,135.43,
"Protein Electro.,S LC",2284165,CDM,301,RC,84165,HCPCS,"OUTPATIENT ",,,188,,,125.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",169.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.03,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,34.99,34.99,34.99,"1 through 10",other,"not separately reimbursment",53.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",178.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",159.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.51,178.6,
"Protein Level 24 Hour Urine",2294156,CDM,301,RC,84156,HCPCS,"OUTPATIENT ",,,71.5,,,47.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.03,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.90,53.90,53.90,"1 through 10",other,"not separately reimbursment",20.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",60.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,67.93,
"Protein S-Antigen LC",2285305,CDM,300,RC,85305,HCPCS,"OUTPATIENT ",,,181.44,,,121.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.58,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",163.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.43,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.58,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",50.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",154.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",108.86,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.43,172.37,
"Protein S-Functional LC",2285306,CDM,300,RC,85306,HCPCS,"OUTPATIENT ",,,173.76,,,116.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",48.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",48.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.06,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",156.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.43,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",48.65,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",165.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.66,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",147.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",48.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges",104.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.66,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.43,165.07,
"Protein Total",2284155,CDM,301,RC,84155,HCPCS,"OUTPATIENT ",,,63,,,42.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",56.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.43,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",59.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",53.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,59.85,
"Protein Total, Qn, 24hr Ur LC",2284156,CDM,301,RC,84156,HCPCS,"OUTPATIENT ",,,71.5,,,47.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.43,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.90,53.90,53.90,"1 through 10",other,"not separately reimbursment",20.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",60.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,67.93,
"Protein Urine",2284156,CDM,301,RC,84156,HCPCS,"OUTPATIENT ",,,71.5,,,47.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.43,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.90,53.90,53.90,"1 through 10",other,"not separately reimbursment",20.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",60.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,67.93,
"Protein,Total,Urine LC",2284156,CDM,301,RC,84156,HCPCS,"OUTPATIENT ",,,71.5,,,47.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",81.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.90,53.90,53.90,"1 through 10",other,"not separately reimbursment",20.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",60.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,81.05,
"Protein,Ttl,U LC",2284156,CDM,301,RC,84156,HCPCS,"OUTPATIENT ",,,71.5,,,47.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",81.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.90,53.90,53.90,"1 through 10",other,"not separately reimbursment",20.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",60.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,81.05,
"Prothrombin Time",2285610,CDM,305,RC,85610,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.55,46.55,47.03,"1 through 10",other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.84,58.9,
"Prothrombin Time (PT) LC",22005199,CDM,300,RC,85610,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",4.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.55,46.55,47.03,"1 through 10",other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.84,58.9,
"Prothrombin Time and INR",2285610,CDM,305,RC,85610,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.31,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.55,46.55,47.03,"1 through 10",other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.94,58.9,
"Prothrombin Time LC",22015289,CDM,300,RC,85610,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.31,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.55,46.55,47.03,"1 through 10",other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.94,58.9,
"PSA Diagnostic",2284153,CDM,301,RC,84153,HCPCS,"OUTPATIENT ",,,43.5,,,29.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",39.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.31,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.18,41.33,
"PSA Total (Reflex To Free) LC",2284153,CDM,301,RC,84153,HCPCS,"OUTPATIENT ",,,43.5,,,29.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",39.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.69,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.18,41.33,
"PSA Total+% Free LC",2284154,CDM,300,RC,84154,HCPCS,"OUTPATIENT ",,,224,,,150.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",201.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",62.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",212.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",190.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.85,212.8,
"PSA, Complexed LC",2284152,CDM,301,RC,84152,HCPCS,"OUTPATIENT ",,,42,,,28.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",37.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",39.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",35.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.76,39.9,
"PSA, Free LC",2284153,CDM,301,RC,84153,HCPCS,"OUTPATIENT ",,,43.5,,,29.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",39.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.18,41.33,
"PSA, Serum (Serial Monitor) LC",2284153,CDM,301,RC,84153,HCPCS,"OUTPATIENT ",,,43.5,,,29.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",39.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",23.13,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",41.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.59,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.18,41.33,
"PT (INR)",2285610,CDM,305,RC,85610,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.55,46.55,47.03,"1 through 10",other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.94,58.9,
"PT Attended E-Stim Assistant Units",4601450,CDM,420,RC,97032,HCPCS,"OUTPATIENT ",,,83,,,55.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",74.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",22.22,78.85,
"PT Biofdbk Peri,Ureth,Rect,1st 15 Charge",4600912,CDM,420,RC,90912,HCPCS,"OUTPATIENT ",,,477,,,319.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",133.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",127.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",133.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",429.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",134.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",127.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",133.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",453.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",405.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",133.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",286.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",130.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",127.69,453.15,
"PT Biofeedback Assistant Units",4600911,CDM,420,RC,90911,HCPCS,"OUTPATIENT ",,,265,,,177.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",70.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",238.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",70.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",251.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",225.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",70.94,251.75,
"PT Biofeedback Units",4600911,CDM,420,RC,90911,HCPCS,"OUTPATIENT ",,,265,,,177.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",70.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",238.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",70.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",251.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",225.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",70.94,251.75,
"PT Canalith Repositioning Assist Units",46015249,CDM,420,RC,95992,HCPCS,"OUTPATIENT ",,,187.33,,,125.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",50.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",168.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",50.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",52.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",159.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",50.15,177.96,
"PT Canalith Repositioning Charge",4601524,CDM,420,RC,95992,HCPCS,"OUTPATIENT ",,,187.33,,,125.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",50.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",168.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",50.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",52.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",159.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",50.15,177.96,
"PT CPM Initial Fit Assitant Charge",46019059,CDM,420,RC,97110,HCPCS,"OUTPATIENT ",,,125.5,,,84.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,141.96,68.01,413.78,"1 through 10",other,"not separately reimbursment",35.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.6,119.23,
"PT Dry Needling, 1-2 Muscles Charges",4620560,CDM,761,RC,20560,HCPCS,"OUTPATIENT ",,,75,,,50.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",67.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",71.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",63.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.08,71.25,
"PT Dry Needling, 3+ Muscles Time",4620561,CDM,420,RC,20561,HCPCS,"OUTPATIENT ",,,70,,,46.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.74,66.5,
"PT Dry Needling, 3+ Muscles Units",4620561,CDM,420,RC,20561,HCPCS,"OUTPATIENT ",,,70,,,46.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",19.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",59.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.74,66.5,
"PT Gait Training Assistant Units",46015209,CDM,420,RC,97116,HCPCS,"OUTPATIENT ",,,42.5,,,28.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",38.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",11.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",36.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.38,40.38,
"PT High Complex Units",4697163,CDM,424,RC,97163,HCPCS,"OUTPATIENT ",,,467.7,,,313.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",130.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",125.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",130.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",420.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,108.42,108.42,108.42,"1 through 10",other,"not separately reimbursment",132.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",125.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",130.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",444.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",397.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",130.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",280.62,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",127.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",125.2,444.32,
"PT Hot, Cold Pack Units",4601550,CDM,420,RC,97010,HCPCS,"OUTPATIENT ",,,73,,,48.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",65.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",69.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",62.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.54,69.35,
"PT Iontophhoresis Assistant Units",46013149,CDM,420,RC,97033,HCPCS,"OUTPATIENT ",,,101,,,67.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",90.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",95.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",85.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",60.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.04,95.95,
"PT LC",2285610,CDM,305,RC,85610,HCPCS,"OUTPATIENT ",,,62,,,41.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",55.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.04,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.55,46.55,47.03,"1 through 10",other,"not separately reimbursment",17.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",17.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",52.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.94,58.9,
"PT Low Complex Units",4697161,CDM,424,RC,97161,HCPCS,"OUTPATIENT ",,,525,,,351.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",140.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",472.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,124.70,124.70,144.30,"1 through 10",other,"not separately reimbursment",148.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",140.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",498.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",446.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147,28,,,,,0,"percent of total billed charges ","28% of total billed charges",315,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",143.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",140.54,498.75,
"PT Lymph Wrap Below Knee Assist Units",4629581,CDM,420,RC,29581,HCPCS,"OUTPATIENT ",,,214,,,143.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",192.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",57.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",203.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",181.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",128.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.29,203.3,
"PT Lymphedema Wrap Arm Charge",4629584,CDM,420,RC,29584,HCPCS,"OUTPATIENT ",,,214,,,143.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",192.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",57.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",203.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",181.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",128.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.29,203.3,
"PT Lymphedema Wrap below Knee Charge",4629581,CDM,420,RC,29581,HCPCS,"OUTPATIENT ",,,214,,,143.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",192.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",57.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",203.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",181.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",128.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.29,203.3,
"PT Manual Therapy Assistant Units",46013389,CDM,420,RC,97140,HCPCS,"OUTPATIENT ",,,144,,,96.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",129.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,56.26,56.26,56.26,"1 through 10",other,"not separately reimbursment",40.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",136.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",122.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",86.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.55,136.8,
"PT Massage Assistant Units",4601331,CDM,420,RC,97124,HCPCS,"OUTPATIENT ",,,114,,,76.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",102.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.52,108.3,
"PT Massage Charge Units",4601331,CDM,420,RC,97124,HCPCS,"OUTPATIENT ",,,114,,,76.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",102.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.52,108.3,
"PT Mechanical Traction Assistant Units",46019209,CDM,420,RC,97012,HCPCS,"OUTPATIENT ",,,146,,,97.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.08,138.7,
"PT Mechanical Traction Units",4601920,CDM,420,RC,97012,HCPCS,"OUTPATIENT ",,,146,,,97.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.08,138.7,
"PT Moderate Complex Units",4697162,CDM,424,RC,97162,HCPCS,"OUTPATIENT ",,,410.5,,,275.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",114.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",114.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",369.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,92.17,92.17,92.17,"1 through 10",other,"not separately reimbursment",116.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",109.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",114.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",389.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",348.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",114.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",246.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",112.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",109.89,389.98,
"PT Neuromuscular Reeducation Assist Unit",46017009,CDM,420,RC,97112,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",41.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.56,143.93,
"PT Orthotic Mgmt, Train Assistant Units",4604720,CDM,420,RC,97760,HCPCS,"OUTPATIENT ",,,150,,,100.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",135,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",40.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",142.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",127.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",40.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",40.16,142.5,
"PT Orthotic Mgmt/Train Establish Charge",4611012,CDM,420,RC,97763,HCPCS,"OUTPATIENT ",,,255,,,170.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",68.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",229.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",68.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",71.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",242.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",216.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",153,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",69.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",68.26,242.25,
"PT Orthotic Mgmt/Train Establish Rehab Units",4611012,CDM,420,RC,97763,HCPCS,"OUTPATIENT ",,,255,,,170.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",68.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",229.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",68.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",71.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",242.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",216.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",153,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",69.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",68.26,242.25,
"PT Prosthetic Mgmt, Train Assistant Units",4601790,CDM,420,RC,97761,HCPCS,"OUTPATIENT ",,,101,,,67.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",90.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",95.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",85.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",60.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.04,95.95,
"PT ReEval Units",4697164,CDM,424,RC,97164,HCPCS,"OUTPATIENT ",,,304.81,,,204.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",81.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",274.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",81.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.35,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",289.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",259.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges",182.89,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",81.6,289.57,
"PT Selective Debridement <20 Units",4601385,CDM,420,RC,97597,HCPCS,"OUTPATIENT ",,,182,,,121.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",163.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",154.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",109.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.72,172.9,
"PT Selective Debridement Add Assist Unit",4601390,CDM,420,RC,97598,HCPCS,"OUTPATIENT ",,,138,,,92.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",124.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",36.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",38.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",131.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",117.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",82.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",37.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",36.94,131.1,
"PT Selective Debridement Assistant Units",4601385,CDM,420,RC,97597,HCPCS,"OUTPATIENT ",,,182,,,121.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",163.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",154.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",109.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.72,172.9,
"PT Self Care, Home Management Charges",4601202,CDM,420,RC,97535,HCPCS,"OUTPATIENT ",,,91,,,60.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",77.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.36,86.45,
"PT Therapeutic Activity Assistant Units",46010459,CDM,420,RC,97530,HCPCS,"OUTPATIENT ",,,90.5,,,60.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",76.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.23,85.98,
"PT Therapeutic Exercise Assit Units",46019009,CDM,420,RC,97110,HCPCS,"OUTPATIENT ",,,125.5,,,84.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,141.96,68.01,413.78,"1 through 10",other,"not separately reimbursment",35.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.6,119.23,
"PT Ultrasound Assistant Units",46019359,CDM,420,RC,97035,HCPCS,"OUTPATIENT ",,,95,,,63.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",90.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.43,90.25,
"PT Unattended E-Stim Assistant Units",46014459,CDM,420,RC,97014,HCPCS,"OUTPATIENT ",,,146,,,97.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.08,138.7,
"PT Unattended E-Stim Units",4601445,CDM,420,RC,97014,HCPCS,"OUTPATIENT ",,,146,,,97.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.08,138.7,
"PT Unna Boot Strapping Assistant Units",4629580,CDM,360,RC,29580,HCPCS,"OUTPATIENT ",,,113,,,75.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",101.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",107.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",67.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.25,107.35,
"PT Wheelchair management Assistant Units",4601965,CDM,420,RC,97542,HCPCS,"OUTPATIENT ",,,56,,,37.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",50.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",47.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.99,53.2,
"PT Wheelchair Management Charges",4601965,CDM,420,RC,97542,HCPCS,"OUTPATIENT ",,,56,,,37.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",50.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",47.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.99,53.2,
"PT Whirlpool, Fluidotherapy Assist Units",4601540,CDM,420,RC,97022,HCPCS,"OUTPATIENT ",,,182,,,121.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",163.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",154.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",109.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.72,172.9,
"PT Whirlpool, Fluidotherapy Units",4601540,CDM,420,RC,97022,HCPCS,"OUTPATIENT ",,,182,,,121.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",163.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",154.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",109.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.72,172.9,
"PTBiofdbk Peri,Ureth,Rect,Addl15Min Unit",4600913,CDM,420,RC,90913,HCPCS,"OUTPATIENT ",,,213,,,142.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",59.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",59.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",191.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",57.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",59.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",202.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",181.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",59.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",127.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",58.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.02,202.35,
"PTH Intact",2283970,CDM,301,RC,83970,HCPCS,"OUTPATIENT ",,,167.5,,,112.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.74,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",150.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,149.01,86.31,185.17,"1 through 10",other,"not separately reimbursment",47.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",159.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.94,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",142.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",100.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.94,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2,159.13,
"PTH, Intact LC",2283970,CDM,301,RC,83970,HCPCS,"OUTPATIENT ",,,167.5,,,112.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.74,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",150.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.73,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,149.01,86.31,185.17,"1 through 10",other,"not separately reimbursment",47.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",159.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.94,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",142.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",100.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.94,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.73,159.13,
"PTHrP (PTH-Related Peptide) LC",2282397,CDM,300,RC,82397,HCPCS,"OUTPATIENT ",,,177,,,118.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.77,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",159.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.73,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.77,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.13,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",150.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.13,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.77,168.15,
"PTT, Activated LC",2285730,CDM,305,RC,85730,HCPCS,"OUTPATIENT ",,,85,,,56.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.54,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.25,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",76.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.04,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,64.19,64.19,64.71,"1 through 10",other,"not separately reimbursment",24.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.54,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",80.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.69,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",72.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.69,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.54,80.75,
"PTT-LA LC",2285732,CDM,305,RC,85732,HCPCS,"OUTPATIENT ",,,54.2,,,36.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.04,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51.49,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",46.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.14,51.49,
"Pulse Oximetry RT",2694760,CDM,460,RC,94760,HCPCS,"OUTPATIENT ",,,32.16,,,21.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",28.94,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",27.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8.61,30.55,
"Purkinje Cell Cyto Ab Type 2 LC",22505575J,CDM,301,RC,86255,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.24,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,325.97,325.97,325.97,"1 through 10",other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.16,376.2,
"Purkinje Cell Cyto Ab Type Tr LC",22505575K,CDM,301,RC,86255,HCPCS,"OUTPATIENT ",,,396,,,265.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",356.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.98,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,325.97,325.97,325.97,"1 through 10",other,"not separately reimbursment",111.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",110.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",376.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",336.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",110.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",237.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.16,376.2,
"QuantiFERON-TB Gold Plus LC",2286480,CDM,302,RC,86480,HCPCS,"OUTPATIENT ",,,573.33,,,384.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",160.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",77.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",160.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",516,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.98,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",162.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",77.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",160.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",544.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",79.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",487.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",160.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",79.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.98,544.66,
"QuantiFERON-TB Plus(Client Incubated) LC",2286480,CDM,302,RC,86480,HCPCS,"OUTPATIENT ",,,573.33,,,384.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",160.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",77.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",160.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",516,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.98,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",162.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",77.93,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",160.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",544.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",79.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",487.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",160.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",79.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.98,544.66,
"Radiofrequency Cervical Ablation w/Fluoro",664633,CDM,360,RC,64633,HCPCS,"OUTPATIENT ",,,1500.55,,,1005.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",420.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",401.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",420.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1350.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",424.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",401.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",420.15,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1425.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1275.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",420.15,28,,,,,0,"percent of total billed charges ","28% of total billed charges",900.33,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",409.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",401.7,1425.52,
"Radiofrequency Lumbar Ablation w/Fluoro",664635,CDM,360,RC,64635,HCPCS,"OUTPATIENT ",,,3146,,,2107.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",880.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",842.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",880.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2831.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",889.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",842.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",880.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2988.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2674.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",880.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1887.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",859.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",842.18,2988.7,
"Rapid Plasma Reagin, Quant LC",2286593,CDM,302,RC,86593,HCPCS,"OUTPATIENT ",,,134.42,,,90.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.05,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",120.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",127.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",114.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",80.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6.05,127.7,
"RBC LC",22005009,CDM,300,RC,85025,HCPCS,"OUTPATIENT ",,,98,,,65.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.77,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",88.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.98,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,132.30,96.09,132.30,11,other,"not separately reimbursment",27.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.77,100,,9.56,9.56,9.56,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",27.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",93.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",83.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",27.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",58.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.97,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.77,93.1,
"REF ABO/Rh",2286900,CDM,302,RC,86900,HCPCS,"OUTPATIENT ",,,121.5,,,81.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",109.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,48.68,15.89,81.47,"1 through 10",other,"not separately reimbursment",34.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",115.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",103.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.83,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.75,115.43,
"REF Antibody Screen",2286850,CDM,302,RC,86850,HCPCS,"OUTPATIENT ",,,127.2,,,85.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.23,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",114.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.25,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,37.73,37.73,37.73,"1 through 10",other,"not separately reimbursment",35.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.23,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",35.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.53,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",108.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.53,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.23,120.84,
"REF Cell Separation",2286972,CDM,300,RC,86972,HCPCS,"OUTPATIENT ",,,769.2,,,515.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",692.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",730.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",653.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",461.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",210.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.91,730.74,
"REF Crossmatch",OB86920,CDM,302,RC,86920,HCPCS,"OUTPATIENT ",,,245.67,,,164.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",221.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",208.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.77,233.39,
"REF Elution",2286860,CDM,302,RC,86860,HCPCS,"OUTPATIENT ",,,154.5,,,103.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",139.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.25,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",43.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",43.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",146.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",131.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",92.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.24,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.12,146.78,
"REF Enzyme Treat",2286971,CDM,302,RC,86971,HCPCS,"OUTPATIENT ",,,252.21,,,168.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",226.99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",239.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",214.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",151.33,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.52,239.6,
"REF RBC, Pre-treat",2286970,CDM,302,RC,86970,HCPCS,"OUTPATIENT ",,,202.44,,,135.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",182.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",192.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",172.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.19,192.32,
"REF Rh Phenotyping",2286906,CDM,302,RC,86906,HCPCS,"OUTPATIENT ",,,674.73,,,452.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",188.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",188.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.66,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",607.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.25,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",190.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.75,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",188.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",640.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",9.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",573.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",188.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",404.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.95,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.75,640.99,
"Removal Tympanostomy tube",OR69424,CDM,360,RC,69424,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"Renal Function Panel",2280069,CDM,301,RC,80069,HCPCS,"OUTPATIENT ",,,118.5,,,79.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.92,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",106.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.25,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,52.16,52.16,52.16,"1 through 10",other,"not separately reimbursment",33.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.92,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",33.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",112.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.14,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",100.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",71.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.14,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.92,112.58,
"Renal Panel (10) LC",2280069,CDM,301,RC,80069,HCPCS,"OUTPATIENT ",,,118.5,,,79.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.92,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",106.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,52.16,52.16,52.16,"1 through 10",other,"not separately reimbursment",33.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.92,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",33.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",112.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.14,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",100.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",71.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.14,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.92,112.58,
"Renin Activity, Plasma LC",2284244,CDM,301,RC,84244,HCPCS,"OUTPATIENT ",,,109.22,,,73.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.66,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",98.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.66,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",103.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",28.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",92.84,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.53,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",25.32,103.76,
"Respiratory Culture",2247070,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
"Respiratory Pathogen Panel, LC 139845",22139845,CDM,300,RC,87633,HCPCS,"OUTPATIENT ",,,417,,,279.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",193.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",242.38,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",375.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",193.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",116.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",396.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",197.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",354.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",250.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",197.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",25.32,396.15,
"Respiratory Pathogens Flex (Verigene)",2277631,CDM,300,RC,87633,HCPCS,"OUTPATIENT ",,,417,,,279.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",193.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",242.38,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",375.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.56,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",193.9,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",116.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",396.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",197.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",354.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",116.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",250.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",197.78,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.56,396.15,
"Respiratory Syncytial Virus Resp LC",22168022,CDM,300,RC,87254,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.56,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.15,57,
"Retic Count Absolute",2285044,CDM,305,RC,85044,HCPCS,"OUTPATIENT ",,,49.5,,,33.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.91,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",44.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.77,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",13.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",42.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.41,47.03,
"Retic Count Manual",2285045,CDM,305,RC,85045,HCPCS,"OUTPATIENT ",,,58,,,38.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",52.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.39,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.03,100,,5.17,5.17,5.17,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",16.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",55.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.13,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",49.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.13,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.03,55.1,
"Reticulocyte Count Automated",2285045,CDM,305,RC,85045,HCPCS,"OUTPATIENT ",,,58,,,38.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",52.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.39,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.03,100,,5.17,5.17,5.17,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",16.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",55.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.13,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",49.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.13,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.03,55.1,
"Reticulocyte Count LC",2285045,CDM,305,RC,85045,HCPCS,"OUTPATIENT ",,,58,,,38.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",52.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.03,100,,5.17,5.17,5.17,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",16.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",55.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.13,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",49.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.13,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.03,55.1,
"Reverse T3, Serum LC",2284482,CDM,300,RC,84482,HCPCS,"OUTPATIENT ",,,288,,,192.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.67,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",259.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.82,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",80.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",273.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.22,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",244.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",172.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.22,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.05,273.6,
"Rh Factor LC",22006049,CDM,305,RC,86901,HCPCS,"OUTPATIENT ",,,38,,,25.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",34.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.05,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,28.95,28.95,28.95,"1 through 10",other,"not separately reimbursment",10.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",36.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",32.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.1,36.1,
"Rh Typing",2286901,CDM,302,RC,86901,HCPCS,"OUTPATIENT ",,,38,,,25.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",34.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.2,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,28.95,28.95,28.95,"1 through 10",other,"not separately reimbursment",10.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.51,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",36.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",32.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.8,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.1,36.1,
"Rheumatoid Arthritis Factor LC",2286431,CDM,302,RC,86431,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.73,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,109.19,49.93,168.45,"1 through 10",other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.14,177.65,
"Rheumatoid Factor Qual",2286431,CDM,302,RC,86431,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",14.73,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,109.19,49.93,168.45,"1 through 10",other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.14,177.65,
"Rheumatoid Factor Qualitative",2286430,CDM,302,RC,86430,HCPCS,"OUTPATIENT ",,,171.6,,,114.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",48.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",48.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",154.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",48.05,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",163.02,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",145.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",48.05,28,,,,,0,"percent of total billed charges ","28% of total billed charges",102.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.14,163.02,
"Rheumatoid Factor Titer",2286431,CDM,302,RC,86431,HCPCS,"OUTPATIENT ",,,187,,,125.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",168.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,109.19,49.93,168.45,"1 through 10",other,"not separately reimbursment",52.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",52.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",177.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",158.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",112.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.28,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.14,177.65,
"Rocky Mtn Spotted Fever, IgM LC",2286757,CDM,300,RC,86757,HCPCS,"OUTPATIENT ",,,168.74,,,113.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",151.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",17.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.84,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.07,160.3,
"RPR LC",2286592,CDM,302,RC,86592,HCPCS,"OUTPATIENT ",,,55.77,,,37.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",50.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.32,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",47.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.65,52.98,
"RPR, Rfx Qn RPR/Confirm TP LC",2286592,CDM,302,RC,86592,HCPCS,"OUTPATIENT ",,,55.77,,,37.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",50.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",47.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.65,52.98,
RSV,2287420,CDM,300,RC,87420,HCPCS,"OUTPATIENT ",,,15.5,,,10.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",13.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,20.58,20.58,20.87,"1 through 10",other,"not separately reimbursment",4.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",4.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",13.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.34,16.49,
"RSV (Sofia)",2287420,CDM,300,RC,87420,HCPCS,"OUTPATIENT ",,,15.5,,,10.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",13.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,20.58,20.58,20.87,"1 through 10",other,"not separately reimbursment",4.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",4.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",13.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.34,16.85,
"RSV POCT",2287420,CDM,300,RC,87420,HCPCS,"OUTPATIENT ",,,15.5,,,10.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",13.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,20.58,20.58,20.87,"1 through 10",other,"not separately reimbursment",4.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",4.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",13.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.34,53.36,
"RSV, NAA LC",22140144,CDM,300,RC,87634,HCPCS,"OUTPATIENT ",,,370,,,247.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",103.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.33,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",103.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",333,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",104.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",69.33,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",103.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",351.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",70.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",314.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",103.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",222,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",70.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",53.36,351.5,
"RT Aerosol Initial CHARGE",RT94640I,CDM,410,RC,94640,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"RT Aerosol Subsequent CHARGE",RT94640S,CDM,410,RC,94640,HCPCS,"OUTPATIENT ",,,203,,,136.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",182.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",192.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",172.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.34,192.85,
"RT BiPAP Initial CHARGE",RT94660I,CDM,410,RC,94660,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"RT BiPAP Subsequent CHARGE",RT94660S,CDM,410,RC,94660,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"RT Cardiopulmonary Resuscitation CHARGE",2614001,CDM,410,RC,92950,HCPCS,"OUTPATIENT ",,,1054.56,,,706.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",282.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",949.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",298.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",282.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",295.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1001.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",896.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",295.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",632.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",288,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",282.31,1001.83,
"RT CPAP Initial CHARGE",RT94660I,CDM,410,RC,94660,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"RT CPAP Subsequent CHARGE",RT94660S,CDM,410,RC,94660,HCPCS,"OUTPATIENT ",,,249.5,,,167.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.79,237.03,
"RT Meter Dose Inhaler Initial CHARGE",RT94640I,CDM,410,RC,94640,HCPCS,"OUTPATIENT ",,,203,,,136.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",182.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",192.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",172.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.34,192.85,
"RT Meter Dose Inhaler Subsequent CHARGE",RT94640S,CDM,410,RC,94640,HCPCS,"OUTPATIENT ",,,203,,,136.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",182.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",192.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",172.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",121.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.34,192.85,
"RT Stress Test Treadmill CHARGE",2693015,CDM,482,RC,93015,HCPCS,"OUTPATIENT ",,,2832.5,,,1897.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",758.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2549.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1028.58,1028.58,1028.58,"1 through 10",other,"not separately reimbursment",801.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",758.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",793.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2690.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2407.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1699.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",773.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",758.26,2690.88,
"Rubella Antibodies, IgG LC",2286762,CDM,302,RC,86762,HCPCS,"OUTPATIENT ",,,45.08,,,30.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",40.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",42.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",38.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.62,53.36,
"Rubella Antibodies, IgM LC",2286762,CDM,302,RC,86762,HCPCS,"OUTPATIENT ",,,45.08,,,30.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",40.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",42.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",38.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",27.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.62,53.36,
"Rubeola Antibodies, IgM LC",2276765,CDM,302,RC,86765,HCPCS,"OUTPATIENT ",,,147.17,,,98.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",132.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",41.21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",139.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",125.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.2,139.81,
"Saccharomyces cerevisiae, IgA LC",2233520,CDM,302,RC,86671,HCPCS,"OUTPATIENT ",,,262,,,175.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.85,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",235.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",73.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",248.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",222.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",157.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.42,248.9,
"Saccharomyces cerevisiae, IgG LC",2243520,CDM,302,RC,86671,HCPCS,"OUTPATIENT ",,,262,,,175.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.85,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",235.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",73.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",248.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",222.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",157.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.42,248.9,
"Sacroiliac Joint Radiofrequency w/Fluoro",664640,CDM,360,RC,64625,HCPCS,"OUTPATIENT ",,,920.92,,,617.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",257.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",246.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",257.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",828.83,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",260.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",246.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",257.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",874.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",782.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",257.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",552.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",251.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",246.53,874.87,
"Salicylate Level",2280196,CDM,301,RC,80179,HCPCS,"OUTPATIENT ",,,84,,,56.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.91,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",75.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",19.35,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.91,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",23.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",79.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",71.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",50.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.91,79.8,
"Salmonella/Shigella Scrn LC",22008722,CDM,306,RC,87045,HCPCS,"OUTPATIENT ",,,42,,,28.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",37.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",11.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",39.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",35.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.24,39.9,
"SARS/Flu AB (Sofia)",2287426,CDM,300,RC,87428,HCPCS,"OUTPATIENT ",,,153,,,102.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",137.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",43.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",145.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",68.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",130.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",91.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.42,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.22,145.35,
"SARS-COV- 2 (COVID-19) Abs LC",2286769,CDM,301,RC,86769,HCPCS,"OUTPATIENT ",,,185.5,,,124.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",166.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.83,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",51.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",176.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",157.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",111.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.83,176.23,
"SARS-CoV or CoV-2 (COVID-19) Ag (Sofia)",2287426,CDM,300,RC,87426,HCPCS,"OUTPATIENT ",,,37,,,24.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",33.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,36.26,25.96,36.26,"1 through 10",other,"not separately reimbursment",10.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",36.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.9,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.36,36.9,
"SARS-CoV-2 (COVID-19) Antibody, IgG LC",2250002,CDM,301,RC,86769,HCPCS,"OUTPATIENT ",,,185.5,,,124.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",166.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",51.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",176.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",157.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",111.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.85,176.23,
"SARS-CoV-2 (COVID-19) Antibody, IgM LC",2286769,CDM,301,RC,86769,HCPCS,"OUTPATIENT ",,,185.5,,,124.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",166.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",51.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",176.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",157.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",111.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.85,176.23,
"SARS-CoV-2 (COVID-19) PCR (GeneXpert)",2290004,CDM,301,RC,86769,HCPCS,"OUTPATIENT ",,,185.5,,,124.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",166.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",51.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",176.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",157.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",111.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.85,176.23,
"SARS-CoV-2 (COVID-19) Total Antibodies",2271002,CDM,301,RC,86769,HCPCS,"OUTPATIENT ",,,185.5,,,124.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",166.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",16.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",51.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",176.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",157.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",111.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.85,176.23,
"SARS-CoV-2 (COVID-19)/Flu/RSV (GeneXpert)",2287637,CDM,300,RC,87637,HCPCS,"OUTPATIENT ",,,454,,,304.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",127.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",142.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",127.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",408.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.8,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",142.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",127.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",431.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",145.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",385.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",127.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",272.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",145.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",20.8,431.3,
"SARS-CoV-2 Semi-Quant Spike Ab LC",2286769,CDM,301,RC,86769,HCPCS,"OUTPATIENT ",,,185.5,,,124.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",166.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.8,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",51.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",176.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",157.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",111.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",20.8,176.23,
"SARS-CoV-2(Covid19)PCR(GXpert COVFLURSV)",2286769,CDM,301,RC,86769,HCPCS,"OUTPATIENT ",,,255,,,170.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",229.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.8,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",71.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",242.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",216.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",153,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",20.8,242.25,
"SARS-CoV-2, NAA LC",22140141,CDM,300,RC,87635,HCPCS,"OUTPATIENT ",,,60.5,,,40.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",54.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",20.8,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",51.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",52.34,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.94,57.48,
"Scabies Examination LC",2287169,CDM,301,RC,87169,HCPCS,"OUTPATIENT ",,,26.88,,,18.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",24.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",7.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",22.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.36,25.54,
"Sedimentation Rate (ESR)",2285652,CDM,305,RC,85652,HCPCS,"OUTPATIENT ",,,57.5,,,38.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",51.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.39,54.63,
"Sedimentation Rate (ESR) LC",2285652,CDM,305,RC,85652,HCPCS,"OUTPATIENT ",,,57.5,,,38.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",51.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.39,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.39,54.63,
"Selective Debridement Addition Charge",4601390,CDM,420,RC,97598,HCPCS,"OUTPATIENT ",,,138,,,92.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",36.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",124.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",36.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",38.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",131.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",117.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",82.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",37.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",36.94,131.1,
"Selective Debridement Charge",4601385,CDM,420,RC,97597,HCPCS,"OUTPATIENT ",,,182,,,121.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",163.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",154.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",109.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.72,172.9,
"Selenium, Serum/Plasma LC",2284255,CDM,300,RC,84255,HCPCS,"OUTPATIENT ",,,77.28,,,51.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",69.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.1,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",21.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",73.42,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",65.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",46.37,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.84,73.42,
"Sensory Stimulation Charge",4411533,CDM,430,RC,97533,HCPCS,"OUTPATIENT ",,,104,,,69.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",29.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",29.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",93.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",29.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",98.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",88.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",29.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",62.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.84,98.8,
"Sex Horm Binding Glob, Serum LC",2284270,CDM,301,RC,84270,HCPCS,"OUTPATIENT ",,,144,,,96.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",129.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.84,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",40.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",136.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",27.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",122.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",86.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.84,136.8,
"Sigmoidoscopy Balloon Dilatation Injection",645340,CDM,750,RC,45340,HCPCS,"OUTPATIENT ",,,901.16,,,603.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",252.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",241.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",252.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",811.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",254.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",241.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",252.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",856.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",765.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",252.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",540.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",246.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",241.24,856.1,
"Sigmoidoscopy Diagnostic",610036,CDM,750,RC,45330,HCPCS,"OUTPATIENT ",,,3777.82,,,2531.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1057.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1011.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1057.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3400.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1068.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1011.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1057.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3588.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3211.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1057.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2266.69,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1031.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1011.32,3588.93,
"Sirolimus (Rapamune), Blood LC",2280195,CDM,301,RC,80195,HCPCS,"OUTPATIENT ",,,192,,,128.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",172.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",182.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",163.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",115.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.36,182.4,
"Six Minute Walk",2694620,CDM,460,RC,94620,HCPCS,"OUTPATIENT ",,,249,,,166.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",224.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",236.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",211.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.66,236.55,
"Sjogren's Anti-SS-A LC",2276235,CDM,302,RC,86235,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.65,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.02,213.75,
"Sjogren's Anti-SS-B LC",2296235,CDM,302,RC,86235,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.65,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.02,213.75,
"SLP Cog Ther Intervent, Addl 15 Units",4297130,CDM,440,RC,97130,HCPCS,"OUTPATIENT ",,,43,,,28.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",38.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",36.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.51,40.85,
"SLP Cog Ther Intervent, Addl 15 Units",4297130,CDM,440,RC,97130,HCPCS,"OUTPATIENT ",,,43,,,28.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",38.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",36.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.51,40.85,
"SLP Cog Ther Intervent, Addl 15 Units",4297130,CDM,440,RC,97130,HCPCS,"OUTPATIENT ",,,43,,,28.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",38.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",36.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.51,40.85,
"SLP Cog Ther Intervent1st 15 Min Time",4297129,CDM,440,RC,97129,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.39,47.5,
"SLP Cog Ther Intervent1st 15min Unit",4297129,CDM,440,RC,97129,HCPCS,"OUTPATIENT ",,,50,,,33.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",47.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",42.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",30,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13.39,47.5,
"SLP Speech-Gen Dev Prog and Mod",4202437,CDM,440,RC,92609,HCPCS,"OUTPATIENT ",,,288,,,192.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",77.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",259.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",77.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",80.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",273.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",244.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",172.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",78.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",77.1,273.6,
"SLP Tx Generating Device Units",4202437,CDM,440,RC,92609,HCPCS,"OUTPATIENT ",,,288,,,192.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",77.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",259.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",77.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",80.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",273.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",244.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",80.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",172.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",78.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",77.1,273.6,
"Smear Exam by Pathologist",SEPA85060,CDM,310,RC,85060,HCPCS,"OUTPATIENT ",,,178.14,,,119.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",160.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",169.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",151.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.49,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.02,169.23,
"Smith Antibodies LC",22016360,CDM,301,RC,86235,HCPCS,"OUTPATIENT ",,,225,,,150.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.65,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",202.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",191.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",135,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.02,213.75,
"Sodium Level",2284295,CDM,301,RC,84295,HCPCS,"OUTPATIENT ",,,11.88,,,7.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.05,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",10.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.05,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11.29,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.17,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.33,11.29,
"Sodium Level 24 Hour Urine",2294300,CDM,301,RC,84300,HCPCS,"OUTPATIENT ",,,20.5,,,13.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.75,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",18.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.9,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",17.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.9,19.48,
"Sodium Level Urine",2284300,CDM,301,RC,84300,HCPCS,"OUTPATIENT ",,,20.5,,,13.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.75,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",18.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.9,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",17.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.44,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.9,19.48,
"Speech Fluency Eval Charge",4202521,CDM,440,RC,92521,HCPCS,"OUTPATIENT ",,,110,,,73.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.45,104.5,
"Speech Generating Device Evaluation 1st hr Charge",4292607,CDM,440,RC,92607,HCPCS,"OUTPATIENT ",,,404,,,270.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",108.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",363.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",108.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",113.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",383.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",343.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",242.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",108.15,383.8,
"Speech Sound Prod w/ Language Charge",4202523,CDM,440,RC,92523,HCPCS,"OUTPATIENT ",,,331,,,221.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",297.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",314.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",281.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",88.61,314.45,
"Speech Sound Production Eval Charge",4202522,CDM,440,RC,92522,HCPCS,"OUTPATIENT ",,,250,,,167.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.93,237.5,
"Spirometry - RT CHARGE PFT",2694010,CDM,460,RC,94010,HCPCS,"OUTPATIENT ",,,144.53,,,96.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",130.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",40.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.47,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",137.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",122.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges",86.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.69,137.3,
"Spirometry before & after - RT CHARGE PFT",2694060,CDM,460,RC,94060,HCPCS,"OUTPATIENT ",,,232.06,,,155.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",208.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",220.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",197.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",139.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.12,220.46,
"Sputum Culture",2257070,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.09,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
"Standardized Cognitive Eval Charge",4204125,CDM,440,RC,96125,HCPCS,"OUTPATIENT ",,,95,,,63.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",90.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.43,90.25,
"Stool Culture",2287045,CDM,306,RC,87045,HCPCS,"OUTPATIENT ",,,42,,,28.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",37.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",11.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",39.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",35.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.24,39.9,
"Stool Culture, Vibrio Only LC",2287046,CDM,306,RC,87046,HCPCS,"OUTPATIENT ",,,36,,,24.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.97,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",32.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.09,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.97,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",30.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.03,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.97,34.2,
"Strep A",2287430,CDM,300,RC,87430,HCPCS,"OUTPATIENT ",,,30,,,20.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.14,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.4,28.5,
"Strep A (Sofia)",2287881,CDM,300,RC,87880,HCPCS,"OUTPATIENT ",,,30,,,20.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,40.18,40.18,40.18,"1 through 10",other,"not separately reimbursment",8.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.4,28.5,
"Strep A POCT",2287430,CDM,300,RC,87430,HCPCS,"OUTPATIENT ",,,30,,,20.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.4,28.5,
"Strep A Screen",2287882,CDM,306,RC,87880,HCPCS,"OUTPATIENT ",,,30,,,20.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,40.18,40.18,40.18,"1 through 10",other,"not separately reimbursment",8.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.4,28.5,
"Strep A,B,C,D,F,G Latex",2287077,CDM,306,RC,87077,HCPCS,"OUTPATIENT ",,,33.5,,,22.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",30.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,46.00,46.00,46.00,"1 through 10",other,"not separately reimbursment",9.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.16,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",31.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",28.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.38,31.83,
"Strep Confirmation",2287081,CDM,300,RC,87081,HCPCS,"OUTPATIENT ",,,14,,,9.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.33,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.12,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",12.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.09,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,19.11,19.11,19.11,"1 through 10",other,"not separately reimbursment",3.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.33,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.5,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",11.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.5,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.09,13.3,
"Strep Group A w/ Rfx to Strep C/G",2287880,CDM,306,RC,87880,HCPCS,"OUTPATIENT ",,,30,,,20.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,40.18,40.18,40.18,"1 through 10",other,"not separately reimbursment",8.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.4,28.5,
"Streptococcus Pneumonia Antigen",2267449,CDM,300,RC,87449,HCPCS,"OUTPATIENT ",,,93.5,,,62.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",84.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",26.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",88.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",79.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",56.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.26,88.83,
"Streptococcus Pneumoniae Antigen Urine",2287899,CDM,300,RC,87899,HCPCS,"OUTPATIENT ",,,68,,,45.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",61.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",15.08,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",19.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",64.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",57.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",40.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.26,64.6,
"Stress Test Treadmill",2610001,CDM,482,RC,93015,HCPCS,"OUTPATIENT ",,,2832.5,,,1897.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",758.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2549.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1028.58,1028.58,1028.58,"1 through 10",other,"not separately reimbursment",801.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",758.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",793.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2690.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2407.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",793.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1699.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",773.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",758.26,2690.88,
"Susceptibility, Aer + Anaerob LC",2287186,CDM,306,RC,87186,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,29.00,29.00,29.00,"1 through 10",other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.5,35.63,
"Susceptibility, Anaerobic, MIC  LC",2287186,CDM,306,RC,87186,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,29.00,29.00,29.00,"1 through 10",other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.87,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.09,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.5,35.63,
"Synchronized - Cardioversion Type",4092960,CDM,480,RC,92960,HCPCS,"OUTPATIENT ",,,4555,,,3051.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1219.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4099.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1288.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1219.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1275.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4327.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3871.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1275.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2733,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1243.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1219.37,4327.25,
"T pallidum Ab (FTA-Ab) LC",2286781,CDM,302,RC,86780,HCPCS,"OUTPATIENT ",,,83.04,,,55.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.2,78.89,
"T pallidum Screening Cascade LC",2286780,CDM,302,RC,86780,HCPCS,"OUTPATIENT ",,,83.04,,,55.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.2,78.89,
"T001-IgE Maple/Box Elder LC",22602489,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T003-IgE Common Silver Birch LC",22602936,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T005-IgE Beech (American) LC",22602926,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T006-IgE Cedar, Mountain LC",22602491,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T007-IgE Oak, White LC",22602480,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T008-IgE Elm, American LC",22602476,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T011-IgE Maple Leaf Sycamore LC",22602489,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T012-IgE Willow LC",22602937,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.26,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T014-IgE Cottonwood LC",22602518,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T022-IgE Pecan, Hickory LC",22602533,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T041-IgE Hickory, White LC",22602941,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"T3 Total",2284480,CDM,301,RC,84480,HCPCS,"OUTPATIENT ",,,147.5,,,98.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",132.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,111.23,111.23,111.23,"1 through 10",other,"not separately reimbursment",41.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",41.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",140.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",125.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.57,140.13,
"T3 Uptake",2284479,CDM,301,RC,84479,HCPCS,"OUTPATIENT ",,,57.5,,,38.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",51.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",8.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.14,54.63,
"T3 Uptake LC",2284479,CDM,301,RC,84479,HCPCS,"OUTPATIENT ",,,57.5,,,38.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",51.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.56,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",54.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",34.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.14,54.63,
"T4 Thyroxine LC",22001149,CDM,300,RC,84436,HCPCS,"OUTPATIENT ",,,65.5,,,43.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",58.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.56,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",18.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",62.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.82,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",55.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",39.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.82,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.65,62.23,
"T4, Free(Direct) LC",2284439,CDM,301,RC,84439,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.56,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,195.65,88.18,226.23,12,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.56,218.5,
"Tacrolimus (FK506), Blood LC/MS LC",2280197,CDM,300,RC,80197,HCPCS,"OUTPATIENT ",,,80,,,53.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",10.08,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,58.80,58.80,58.80,"1 through 10",other,"not separately reimbursment",22.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.25,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",22.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.08,76,
"TENS Setup Charge",4411890,CDM,430,RC,64550,HCPCS,"OUTPATIENT ",,,156,,,104.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",140.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.76,148.2,
"TENS Use Charge",4411421,CDM,430,RC,97014,HCPCS,"OUTPATIENT ",,,146,,,97.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.08,138.7,
"Testosterone, Free, Direct LC",2274402,CDM,301,RC,84402,HCPCS,"OUTPATIENT ",,,231.5,,,155.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.01,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",208.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.79,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.01,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.65,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",196.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.65,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",25.79,219.93,
"Testosterone, Serum LC",2284403,CDM,301,RC,84403,HCPCS,"OUTPATIENT ",,,383.5,,,256.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",107.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",107.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",345.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,211.46,211.46,211.46,"1 through 10",other,"not separately reimbursment",108.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.47,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",107.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",364.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",33.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",325.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",107.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",230.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",33.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.57,364.33,
"Testosterone,Free and Total LC",2284402,CDM,301,RC,84402,HCPCS,"OUTPATIENT ",,,231.5,,,155.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.01,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",208.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.01,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",219.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",32.65,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",196.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.65,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.57,219.93,
"Tetanus Antitoxoid IgG Ab LC",2286774,CDM,302,RC,86774,HCPCS,"OUTPATIENT ",,,163,,,109.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",146.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.64,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",45.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",154.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.98,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",138.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",97.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.98,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.64,154.85,
"TgAb+Thyroglobulin,IMA or LCMS LC",2286800,CDM,302,RC,86800,HCPCS,"OUTPATIENT ",,,168.74,,,113.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.86,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",151.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.64,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.64,160.3,
"TgAb+Thyroglobulin,IMA or RIA LC",2286800,CDM,302,RC,86800,HCPCS,"OUTPATIENT ",,,168.74,,,113.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.86,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",151.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.3,160.3,
"Theophylline LC",22007336,CDM,301,RC,80198,HCPCS,"OUTPATIENT ",,,51.84,,,34.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.45,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",46.66,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",49.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.15,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",44.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",31.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.15,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.3,49.25,
"Theophylline Level",2280198,CDM,301,RC,80198,HCPCS,"OUTPATIENT ",,,51.84,,,34.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.45,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",46.66,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",49.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.15,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",44.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",31.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.15,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.3,49.25,
"Therapeutic Activities Charge",4601045,CDM,420,RC,97530,HCPCS,"OUTPATIENT ",,,90.5,,,60.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",81.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",25.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",85.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",76.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",24.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",24.23,85.98,
"Therapeutic Exercise Charges",4601900,CDM,420,RC,97110,HCPCS,"OUTPATIENT ",,,125.5,,,84.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",112.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,141.96,68.01,413.78,"1 through 10",other,"not separately reimbursment",35.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",35.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",119.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",75.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.6,119.23,
"Therapeutic Phlebotomy",2299195,CDM,940,RC,99195,HCPCS,"OUTPATIENT ",,,626.56,,,419.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",175.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",167.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",175.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",563.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,125.00,125.00,125.00,"1 through 10",other,"not separately reimbursment",177.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",167.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",175.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",595.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",532.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",175.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",375.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",171.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",167.73,595.23,
"Thermoactinomyces sacchari IgG LC",22660027,CDM,300,RC,86602,HCPCS,"OUTPATIENT ",,,43,,,28.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",38.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",11.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.3,40.85,
"Thermoactinomyces vulgaris IgG LC",22660118,CDM,300,RC,86602,HCPCS,"OUTPATIENT ",,,43,,,28.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",38.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",12.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",36.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.06,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.07,40.85,
"Thiopurine Methyltransferase LC",2282657,CDM,301,RC,82657,HCPCS,"OUTPATIENT ",,,195,,,130.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.25,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",175.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.55,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",54.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",185.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",165.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",117,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.07,185.25,
"Throat Culture",2267070,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.07,156.28,
"Thrombin Time LC",22500230,CDM,300,RC,85670,HCPCS,"OUTPATIENT ",,,20,,,13.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.26,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.93,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",7.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.26,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.41,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",17,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.41,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.6,19,
"Thyroglob Ab LC",22006786,CDM,300,RC,86800,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.86,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.8,57,
"Thyroglobulin (ICMA) LC",2284432,CDM,301,RC,84432,HCPCS,"OUTPATIENT ",,,56.64,,,37.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",50.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",48.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.6,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.86,53.81,
"Thyroglobulin Antibody LC",2286800,CDM,302,RC,86800,HCPCS,"OUTPATIENT ",,,168.74,,,113.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.86,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",151.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",47.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",160.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",20.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",143.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",101.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.4,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.57,160.3,
"Thyroid Cascade Profile LC",2284443,CDM,301,RC,84443,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,114.64,75.06,116.13,"1 through 10",other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.57,143.93,
"Thyroid Peroxidase (TPO) Ab LC",2286376,CDM,300,RC,86376,HCPCS,"OUTPATIENT ",,,190,,,127.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",171,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.57,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",180.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",161.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.57,180.5,
"Thyroid Stim Immunoglobulin LC",2284445,CDM,301,RC,84445,HCPCS,"OUTPATIENT ",,,74.36,,,49.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.65,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",66.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.82,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",70.64,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",63.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",44.62,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.86,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.65,70.64,
"Thyroid Stimulating Hormone",2284443,CDM,301,RC,84443,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",28.91,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,114.64,75.06,116.13,"1 through 10",other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",21.12,143.93,
"Thyrotropin Receptor Ab, Serum LC",2284443,CDM,301,RC,84443,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,114.64,75.06,116.13,"1 through 10",other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.4,143.93,
"Thyroxine (T4) Free",2284439,CDM,301,RC,84439,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,195.65,88.18,226.23,12,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.4,218.5,
"Thyroxine (T4) LC",2284436,CDM,301,RC,84436,HCPCS,"OUTPATIENT ",,,65.5,,,43.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",58.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",18.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",62.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.82,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",55.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",39.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.82,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.4,62.23,
"Thyroxine (T4) Total",2284436,CDM,301,RC,84436,HCPCS,"OUTPATIENT ",,,65.5,,,43.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",58.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.65,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",18.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",62.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.82,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",55.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",18.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",39.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.82,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.4,62.23,
"Thyroxine (T4), Free, Direct LC",2284439,CDM,301,RC,84439,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,195.65,88.18,226.23,12,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.4,218.5,
"Thyroxine Binding Globulin LC",2284442,CDM,300,RC,84442,HCPCS,"OUTPATIENT ",,,443,,,296.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",124.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",124.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",398.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",125.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",124.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",420.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",376.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",124.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",265.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.4,420.85,
"TIBC (Iron.Bind.Cap) LC",22001347,CDM,300,RC,83550,HCPCS,"OUTPATIENT ",,,177.5,,,118.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.02,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",159.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.4,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,43.68,5.37,94.81,"1 through 10",other,"not separately reimbursment",50.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",150.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.4,168.63,
"Tissue Culture",2247070,CDM,306,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",39.56,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
Tonsillectomy,OR42825,CDM,360,RC,42825,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"Tonsillectomy and Adenoidectomy",OR42820,CDM,360,RC,42820,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"Total Iron Binding Capacity",2283550,CDM,301,RC,83550,HCPCS,"OUTPATIENT ",,,177.5,,,118.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.02,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",159.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",39.56,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,43.68,5.37,94.81,"1 through 10",other,"not separately reimbursment",50.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",150.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.99,168.63,
"Total T4 Level",2284439,CDM,301,RC,84439,HCPCS,"OUTPATIENT ",,,230,,,154.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",207,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",39.56,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,195.65,88.18,226.23,12,other,"not separately reimbursment",65.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.34,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",64.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",218.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",195.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",138,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.57,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.34,218.5,
"Toxoplasma gondii Ab, IgG, Qn LC",2286777,CDM,300,RC,86777,HCPCS,"OUTPATIENT ",,,111,,,74.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",31.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",105.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",94.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.92,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.63,105.45,
"Toxoplasma gondii Ab,IgM LC",2286778,CDM,300,RC,86778,HCPCS,"OUTPATIENT ",,,138,,,92.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.11,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",124.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.11,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",38.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",131.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",117.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",38.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",82.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,131.1,
"TPO Ab LC",22006676,CDM,300,RC,86376,HCPCS,"OUTPATIENT ",,,190,,,127.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.99,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",171,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",180.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",161.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,180.5,
Transferrin,2284466,CDM,301,RC,84466,HCPCS,"OUTPATIENT ",,,255.71,,,171.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.06,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.55,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",230.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.06,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",71.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",242.92,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",217.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",153.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,242.92,
"Transferrin LC",84466,CDM,301,RC,84466,HCPCS,"OUTPATIENT ",,,255.71,,,171.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",71.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.06,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",71.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.55,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",230.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.06,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",71.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",242.92,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",217.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",71.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",153.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.38,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,242.92,
"TRANSFUSE Cryoprecipitate Product",4036430,CDM,391,RC,36430,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,152.22,152.22,152.22,"1 through 10",other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"Transfuse Cryoprecipitate Product",4036430,CDM,391,RC,36430,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,152.22,152.22,152.22,"1 through 10",other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"TRANSFUSE Fresh Frozen Plasma",4036430,CDM,391,RC,36430,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,152.22,152.22,152.22,"1 through 10",other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"Transfuse Fresh Frozen Plasma",4036430,CDM,391,RC,36430,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,152.22,152.22,152.22,"1 through 10",other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"TRANSFUSE Platelet Product",4036430,CDM,391,RC,36430,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,152.22,152.22,152.22,"1 through 10",other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"Transfuse Platelet Product",4036430,CDM,391,RC,36430,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,152.22,152.22,152.22,"1 through 10",other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"Transfuse Red Blood Cells",4036430,CDM,391,RC,36430,HCPCS,"OUTPATIENT ",,,422.5,,,283.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",380.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,152.22,152.22,152.22,"1 through 10",other,"not separately reimbursment",119.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",118.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",401.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",359.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",118.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",253.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",115.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",113.1,401.38,
"Treatment of Swallowing Dysfunction Charge",4202435,CDM,440,RC,92526,HCPCS,"OUTPATIENT ",,,272.72,,,182.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",76.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",73.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",76.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",245.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",73.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",76.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",259.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",231.81,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",76.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",163.63,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",74.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",73.01,259.08,
"Treponema pallidum Antibodies LC",2286780,CDM,302,RC,86780,HCPCS,"OUTPATIENT ",,,83.04,,,55.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",74.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",23.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",78.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",70.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",23.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",18.2,78.89,
"Trich vag by NAA LC",2287661,CDM,306,RC,87661,HCPCS,"OUTPATIENT ",,,150,,,100.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",135,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",18.81,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",142.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",127.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",18.81,142.5,
"Trich Vag, NAA LC",2287661,CDM,306,RC,87661,HCPCS,"OUTPATIENT ",,,150,,,100.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",135,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.42,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",142.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",127.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.85,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.51,142.5,
Triglyceride,2284478,CDM,301,RC,84478,HCPCS,"OUTPATIENT ",,,39.5,,,26.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",35.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",13.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",37.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",33.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",23.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,37.53,
"Triglycerides LC",22001175,CDM,300,RC,84478,HCPCS,"OUTPATIENT ",,,39.5,,,26.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",35.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",37.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",33.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",23.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,37.53,
"Triglycerides, Fluid LC",2274478,CDM,301,RC,84478,HCPCS,"OUTPATIENT ",,,39.5,,,26.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",35.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",28.39,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.35,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",37.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",33.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",23.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.35,37.53,
"Triiodothyronine (T3) LC",2284480,CDM,301,RC,84480,HCPCS,"OUTPATIENT ",,,147.5,,,98.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",132.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,111.23,111.23,111.23,"1 through 10",other,"not separately reimbursment",41.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.03,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",41.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",140.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",125.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,140.13,
"Triiodothyronine (T3), Free LC",2284481,CDM,301,RC,84481,HCPCS,"OUTPATIENT ",,,184.5,,,123.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",51.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",51.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",166.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.3,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",51.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",175.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",156.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",51.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",110.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.73,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,175.28,
Trop-I,2264484,CDM,301,RC,84484,HCPCS,"OUTPATIENT ",,,145,,,97.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.38,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",130.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,109.27,99.22,109.94,"1 through 10",other,"not separately reimbursment",41.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12.38,100,,12.69,12.69,12.69,"1 through 10","fee schedule","100% of AR Medicaid fee Schedule",40.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",137.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",12.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",123.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12.63,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",12.38,137.75,
"Tryptase LC",2223520,CDM,301,RC,83520,HCPCS,"OUTPATIENT ",,,113.68,,,76.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",102.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",31.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",108,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",96.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",68.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,108,
"TSH LC",2284443,CDM,301,RC,84443,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,114.64,75.06,116.13,"1 through 10",other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,143.93,
"TSH w/ Rflx to Free T4",2284443,CDM,301,RC,84443,HCPCS,"OUTPATIENT ",,,151.5,,,101.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",136.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,114.64,75.06,116.13,"1 through 10",other,"not separately reimbursment",42.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.12,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",42.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",143.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",128.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",42.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",90.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",21.54,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,143.93,
"Ttl Insulin LC",2283525,CDM,301,RC,83525,HCPCS,"OUTPATIENT ",,,173.8,,,116.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",48.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.38,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",48.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",156.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.38,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",48.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",165.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",147.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",48.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",104.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.38,165.11,
"t-Transglutaminase (tTG) IgA LC",2273516,CDM,300,RC,83516,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.45,456,
"t-Transglutaminase (tTG) IgG LC",2283516,CDM,301,RC,83516,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.63,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13.45,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",13.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13.72,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",13.45,456,
Turbinectomy,610999,CDM,360,RC,30140,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"Tx of Speech/Lang/Voice/Comm/Auditory Chg",4202070,CDM,440,RC,92507,HCPCS,"OUTPATIENT ",,,300,,,201,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",270,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",285,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",255,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.31,285,
"Tx of Speech/Lang/Voice/Comm/Auditory Chg Medicaid",4202070,CDM,440,RC,92507,HCPCS,"OUTPATIENT ",,,300,,,201,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",270,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",285,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",255,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.31,285,
Tympanoplasty,OR69631,CDM,360,RC,69631,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"U Culture,Comprehensive LC",2287086,CDM,301,RC,87086,HCPCS,"OUTPATIENT ",,,13,,,8.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",11.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",37.63,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,17.64,5.12,17.64,"1 through 10",other,"not separately reimbursment",3.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",11.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.64,37.63,
"UA Microscopic",22281001,CDM,307,RC,81001,HCPCS,"OUTPATIENT ",,,53.5,,,35.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",69.76,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,144.06,88.88,144.06,"1 through 10",other,"not separately reimbursment",15.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",50.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.99,69.76,
"uE3 Value LC",22017377,CDM,300,RC,82677,HCPCS,"OUTPATIENT ",,,359.34,,,240.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",100.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",100.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.25,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",323.41,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",101.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",100.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",341.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",31.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",305.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",100.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",215.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",31.02,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,341.37,
"Ultrasound Charges",4411935,CDM,430,RC,97035,HCPCS,"OUTPATIENT ",,,95,,,63.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",90.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.43,90.25,
"Ultrasound Charges",4601935,CDM,420,RC,97035,HCPCS,"OUTPATIENT ",,,95,,,63.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",85.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",90.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.43,90.25,
"Unattended Electrical Therapy Charge",4601445,CDM,420,RC,97014,HCPCS,"OUTPATIENT ",,,146,,,97.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",39.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",131.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",39.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",124.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",39.08,138.7,
"Unlisted procedure, lips 40799",240799,CDM,450,RC,40799,HCPCS,"OUTPATIENT ",,,700,,,469,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",187.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",630,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",197.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",187.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",196,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",665,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",595,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges",420,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",191.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",187.39,665,
"Unna Boot Strapping Charge",4629580,CDM,360,RC,29580,HCPCS,"OUTPATIENT ",,,113,,,75.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",101.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",30.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",31.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",107.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",96.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",31.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",67.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",30.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",30.25,107.35,
"Upper Respiratory Culture LC",2287070,CDM,301,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.83,156.28,
"Urea Clearance",2284545,CDM,301,RC,84545,HCPCS,"OUTPATIENT ",,,134,,,89.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",120.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.31,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",127.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",113.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",80.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.48,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.31,127.3,
"Uric Acid",2284550,CDM,301,RC,84550,HCPCS,"OUTPATIENT ",,,133,,,89.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.21,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",119.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,45.60,36.87,59.86,"1 through 10",other,"not separately reimbursment",37.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.79,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",113.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.79,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.68,126.35,
"Uric Acid LC",2284550,CDM,301,RC,84550,HCPCS,"OUTPATIENT ",,,133,,,89.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.21,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",119.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,45.60,36.87,59.86,"1 through 10",other,"not separately reimbursment",37.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.68,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",37.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.79,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",113.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.79,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.68,126.35,
"Uric Acid, Body Fluid LC",2274560,CDM,301,RC,84560,HCPCS,"OUTPATIENT ",,,22.08,,,14.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",19.87,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.98,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",6.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",18.77,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",13.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.1,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.98,25.66,
"Urinalysis Dipstick Only",2271003,CDM,307,RC,81003,HCPCS,"OUTPATIENT ",,,21,,,14.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.09,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",18.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",2.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",17.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.83,25.66,
"Urinalysis w/Microscopic",2281001,CDM,307,RC,81001,HCPCS,"OUTPATIENT ",,,53.5,,,35.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",56.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,144.06,88.88,144.06,"1 through 10",other,"not separately reimbursment",15.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",50.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.99,56.02,
"Urinalysis with Microscopic",2281001,CDM,307,RC,81001,HCPCS,"OUTPATIENT ",,,53.5,,,35.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",218.81,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,144.06,88.88,144.06,"1 through 10",other,"not separately reimbursment",15.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",50.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.99,218.81,
"Urinalysis, Complete LC",2281001,CDM,307,RC,81001,HCPCS,"OUTPATIENT ",,,53.5,,,35.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",48.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",346.76,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,144.06,88.88,144.06,"1 through 10",other,"not separately reimbursment",15.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",50.83,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",45.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.07,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.99,346.76,
"Urine Calcium",2282340,CDM,301,RC,82340,HCPCS,"OUTPATIENT ",,,91.52,,,61.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",56.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.59,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.94,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.74,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.59,86.94,
"Urine Culture",2287086,CDM,301,RC,87086,HCPCS,"OUTPATIENT ",,,39,,,26.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",35.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",56.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,17.64,5.12,17.64,"1 through 10",other,"not separately reimbursment",11.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",37.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",33.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",23.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.15,56.02,
"Urine Culture, Routine LC",2287086,CDM,301,RC,87086,HCPCS,"OUTPATIENT ",,,39,,,26.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",35.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",56.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,17.64,5.12,17.64,"1 through 10",other,"not separately reimbursment",11.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",37.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",10.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",33.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",23.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.35,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",10.15,56.02,
"Urine Cytology LC",22009068,CDM,303,RC,88112,HCPCS,"OUTPATIENT ",,,445,,,298.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",124.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",124.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",400.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",56.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",125.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.19,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",124.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",422.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",108.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",378.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",124.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",267,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.31,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",56.02,422.75,
"Urine Microalbumin",2282043,CDM,301,RC,82043,HCPCS,"OUTPATIENT ",,,194.5,,,130.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",175.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",56.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.05,142.05,142.05,"1 through 10",other,"not separately reimbursment",55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.28,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",54.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",184.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",7.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",165.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",116.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.28,184.78,
"Urine Pregnancy Qual POCT",2281025,CDM,307,RC,81025,HCPCS,"OUTPATIENT ",,,30,,,20.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.96,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",25.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",7.96,28.5,
"Urine Protein Level",2284156,CDM,301,RC,84156,HCPCS,"OUTPATIENT ",,,71.5,,,47.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",64.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,53.90,53.90,53.90,"1 through 10",other,"not separately reimbursment",20.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.61,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",20.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",67.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",60.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",42.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.61,67.93,
"US AAA Screening",1876706,CDM,402,RC,76706,HCPCS,"OUTPATIENT ",,,570,,,381.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",159.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",152.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",159.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",513,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",161.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",152.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",159.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",541.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",484.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",159.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",342,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",155.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",152.59,541.5,
"US Abdomen Complete",1876700,CDM,402,RC,76700,HCPCS,"OUTPATIENT ",,,1446.5,,,969.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",405.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",387.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",405.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",273.48,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1301.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,437.68,437.68,437.68,"1 through 10",other,"not separately reimbursment",409.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",387.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",405.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1374.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1229.53,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",405.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",867.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",395.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",273.48,1374.18,
"US Abdomen Limited",1876705,CDM,402,RC,76705,HCPCS,"OUTPATIENT ",,,513,,,343.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",143.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",137.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",143.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",210.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",461.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,178.14,111.85,649.89,"1 through 10",other,"not separately reimbursment",145.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",137.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",143.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",487.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",436.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",143.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",307.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",137.33,487.35,
"US Ankle Brachial Index",1893922,CDM,921,RC,93922,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,41.94,41.94,41.94,"1 through 10",other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",128.5,456,
"US Aorta IVC Iliac Duplex Complete",1893978,CDM,921,RC,93978,HCPCS,"OUTPATIENT ",,,527,,,353.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",141.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",474.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",149.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",141.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",500.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",447.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",316.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",143.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",141.08,500.65,
"US Art/Vein Abd/Pelvis/Scrotal Complete",1893975,CDM,921,RC,93975,HCPCS,"OUTPATIENT ",,,1639.5,,,1098.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",459.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",438.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",459.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1475.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",463.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",438.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",459.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1557.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1393.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",459.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",983.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",447.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",438.89,1557.53,
"US Art/Vein Abd/Pelvis/Scrotal Limited",1893976,CDM,921,RC,93976,HCPCS,"OUTPATIENT ",,,555.75,,,372.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",155.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",148.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",155.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",500.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",157.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",148.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",155.61,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",527.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",472.39,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",155.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges",333.45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",151.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",148.77,527.96,
"US Aspiration Abscess/Hematoma/Cyst",1876944,CDM,361,RC,76942,HCPCS,"OUTPATIENT ",,,1072.5,,,718.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",287.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",394.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",965.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",287.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",300.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1018.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",911.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",643.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",292.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",287.11,1018.88,
"US Biopsy Liver",1847000,CDM,402,RC,76942,HCPCS,"OUTPATIENT ",,,1072.5,,,718.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",287.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",394.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",965.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",287.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",300.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1018.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",911.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",643.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",292.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",287.11,1018.88,
"US Biopsy Lymph Node",1838505,CDM,402,RC,76942,HCPCS,"OUTPATIENT ",,,1072.5,,,718.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",287.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",394.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",965.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",287.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",300.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1018.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",911.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",643.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",292.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",287.11,1018.88,
"US Biopsy Muscle Superficial",1820200,CDM,402,RC,20200,HCPCS,"OUTPATIENT ",,,804,,,538.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",225.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",215.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",225.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",723.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",227.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",215.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",225.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",763.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",683.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",225.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",482.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",219.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",215.23,763.8,
"US Breast Biopsy w/ US Guide Left",1819083,CDM,361,RC,19083,HCPCS,"OUTPATIENT ",,,8992.31,,,6024.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2517.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2407.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2517.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",8093.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,2249.51,1515.28,2983.74,"1 through 10",other,"not separately reimbursment",2543.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2407.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2517.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8542.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7643.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2517.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5395.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2455.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2407.24,8542.69,
"US Breast Biopsy w/ US Guide Left.",1819083,CDM,361,RC,19083,HCPCS,"OUTPATIENT ",,,5994.87,,,4016.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1678.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1604.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1678.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5395.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,2249.51,1515.28,2983.74,"1 through 10",other,"not separately reimbursment",1695.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1604.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1678.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5695.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5095.64,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1678.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3596.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1637.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1604.83,5695.13,
"US Breast Biopsy w/ US Guide Right",1819081,CDM,361,RC,19083,HCPCS,"OUTPATIENT ",,,8992.31,,,6024.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2517.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2407.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2517.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",8093.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,2249.51,1515.28,2983.74,"1 through 10",other,"not separately reimbursment",2543.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2407.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2517.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8542.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7643.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2517.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5395.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2455.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2407.24,8542.69,
"US Breast Cyst Aspiration Left",1819001,CDM,361,RC,19000,HCPCS,"OUTPATIENT ",,,597,,,399.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",167.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",167.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",537.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",167.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",567.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",507.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",167.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",358.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",163.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.82,567.15,
"US Breast Cyst Aspiration Right",1819000,CDM,361,RC,19000,HCPCS,"OUTPATIENT ",,,597,,,399.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",167.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",167.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",537.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",167.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",567.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",507.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",167.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",358.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",163.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.82,567.15,
"US Breast Device Plcmnt w/US Guide Left",1819285,CDM,401,RC,19285,HCPCS,"OUTPATIENT ",,,1061,,,710.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",297.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",284.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",297.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",954.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",300.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",284.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",297.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",297.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",284.03,1007.95,
"US Breast Device Plcmnt w/US Guide Right",1819285,CDM,401,RC,19285,HCPCS,"OUTPATIENT ",,,1061,,,710.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",297.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",284.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",297.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",954.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",300.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",284.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",297.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",297.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",284.03,1007.95,
"US Breast Limited Left",1876647,CDM,402,RC,76642,HCPCS,"OUTPATIENT ",,,1326,,,888.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",354.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1193.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",374.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",354.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",371.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1259.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1127.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",795.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",354.97,1259.7,
"US Breast Limited Left.",1876647,CDM,402,RC,76642,HCPCS,"OUTPATIENT ",,,1326,,,888.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",354.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1193.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",374.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",354.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",371.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1259.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1127.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",795.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",354.97,1259.7,
"US Breast Limited Right",1876646,CDM,402,RC,76642,HCPCS,"OUTPATIENT ",,,1326,,,888.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",354.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1193.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",374.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",354.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",371.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1259.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1127.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",795.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",354.97,1259.7,
"US Breast Limited Right.",1876646,CDM,402,RC,76642,HCPCS,"OUTPATIENT ",,,1326,,,888.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",354.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1193.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",374.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",354.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",371.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1259.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1127.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",371.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",795.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",354.97,1259.7,
"US Carotid Duplex Bilateral",1893880,CDM,921,RC,93880,HCPCS,"OUTPATIENT ",,,1700.25,,,1139.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",476.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",455.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",476.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1530.23,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,198.82,198.82,198.82,"1 through 10",other,"not separately reimbursment",480.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",455.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",476.07,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1615.24,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1445.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",476.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1020.15,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",464.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",455.16,1615.24,
"US Chest",1876604,CDM,402,RC,76604,HCPCS,"OUTPATIENT ",,,661.4,,,443.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",185.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",177.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",185.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.81,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",595.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",187.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",177.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",185.19,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",628.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",562.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",185.19,28,,,,,0,"percent of total billed charges ","28% of total billed charges",396.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",180.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.81,628.33,
"US Drain Visceral Fluid w/Cath Perc",1875989,CDM,402,RC,75989,HCPCS,"OUTPATIENT ",,,1392,,,932.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",389.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",372.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",389.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",245.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1252.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",393.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",372.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",389.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1322.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1183.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",389.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",835.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",380.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",245.11,1322.4,
"US Extremity Nonvascular Complete Left",1876883,CDM,402,RC,76881,HCPCS,"OUTPATIENT ",,,1145.45,,,767.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",320.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",306.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",320.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1030.91,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",323.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",306.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",320.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1088.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",973.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",320.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",687.27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",312.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.24,1088.18,
"US Extremity Nonvascular Complete Right",1876882,CDM,402,RC,76881,HCPCS,"OUTPATIENT ",,,1145.45,,,767.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",320.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",306.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",320.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1030.91,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",323.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",306.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",320.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1088.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",973.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",320.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",687.27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",312.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.24,1088.18,
"US Extremity Nonvascular Limited Left",1876885,CDM,402,RC,76882,HCPCS,"OUTPATIENT ",,,1047.5,,,701.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",942.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",69.72,995.13,
"US Extremity Nonvascular Limited Right",1876884,CDM,402,RC,76882,HCPCS,"OUTPATIENT ",,,1047.5,,,701.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",942.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",69.72,995.13,
"US Fine Needle Aspiration w/ Guidance",1810022,CDM,402,RC,10005,HCPCS,"OUTPATIENT ",,,5245.5,,,3514.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1468.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1404.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1468.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4720.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1483.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1404.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1468.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4983.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4458.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1468.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3147.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1432.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1404.22,4983.23,
"US Guided Needle Placement",1876944,CDM,361,RC,76942,HCPCS,"OUTPATIENT ",,,1072.5,,,718.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",287.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",394.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",965.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",287.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",300.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1018.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",911.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",643.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",292.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",287.11,1018.88,
"US Guided Needle Placement",1876944,CDM,361,RC,76942,HCPCS,"OUTPATIENT ",,,1072.5,,,718.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",287.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",394.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",965.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",287.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",300.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1018.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",911.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",300.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",643.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",292.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",287.11,1018.88,
"US Head/Neck Soft Tissue",1876536,CDM,402,RC,76536,HCPCS,"OUTPATIENT ",,,1047.5,,,701.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",942.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,65.72,65.72,65.72,"1 through 10",other,"not separately reimbursment",296.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.35,995.13,
"US Hips Infant Dynamic",1876887,CDM,402,RC,76885,HCPCS,"OUTPATIENT ",,,460,,,308.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",289.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",414,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.14,437,
"US Hips Infant Static Limited",1876886,CDM,402,RC,76886,HCPCS,"OUTPATIENT ",,,189,,,126.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",52.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",50.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",52.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.32,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",170.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",50.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",52.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",179.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",160.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",52.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",113.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",51.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",50.6,205.32,
"US Lower Ext Arterial Duplex Bilateral",1893925,CDM,921,RC,93925,HCPCS,"OUTPATIENT ",,,2252.74,,,1509.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",630.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",603.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",630.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2027.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,445.09,445.09,445.09,"1 through 10",other,"not separately reimbursment",637.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",603.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",630.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2140.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1914.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",630.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1351.64,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",615.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",603.06,2140.1,
"US Lower Ext Arterial Duplex Left",1893927,CDM,921,RC,93926,HCPCS,"OUTPATIENT ",,,436,,,292.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",116.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",392.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",116.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",122.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",414.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",370.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",261.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",119.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",116.72,414.2,
"US Lower Ext Arterial Duplex Right",1893926,CDM,921,RC,93926,HCPCS,"OUTPATIENT ",,,436,,,292.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",116.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",392.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",116.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",122.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",414.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",370.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",261.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",119.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",116.72,414.2,
"US Lower Ext Venous Duplex Bilateral",1893970,CDM,921,RC,93970,HCPCS,"OUTPATIENT ",,,2334.7,,,1564.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",653.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",625,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",653.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2101.23,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",625,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",653.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2217.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1984.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",653.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1400.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",637.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",625,2217.97,
"US Lower Ext Venous Duplex Left",1893972,CDM,921,RC,93971,HCPCS,"OUTPATIENT ",,,3035.5,,,2033.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2731.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,813.69,513.15,813.69,"1 through 10",other,"not separately reimbursment",858.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",812.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",849.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2883.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2580.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1821.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",829,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",812.6,2883.73,
"US Lower Ext Venous Duplex Right",1893971,CDM,921,RC,93971,HCPCS,"OUTPATIENT ",,,3035.5,,,2033.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2731.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,813.69,513.15,813.69,"1 through 10",other,"not separately reimbursment",858.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",812.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",849.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2883.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2580.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1821.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",829,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",812.6,2883.73,
"US Lymph Node Biopsy",1838505,CDM,402,RC,38505,HCPCS,"OUTPATIENT ",,,1265.12,,,847.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",354.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",338.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",354.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1138.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",357.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",338.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",354.23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1201.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1075.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",354.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",759.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",345.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",338.67,1201.86,
"US OB < 14 weeks w/ TVS if indicated",1876801,CDM,402,RC,76801,HCPCS,"OUTPATIENT ",,,313.2,,,209.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",83.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",281.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",88.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",83.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",87.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",297.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",266.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",187.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",85.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",83.84,297.54,
"US OB Limited",1876815,CDM,402,RC,76815,HCPCS,"OUTPATIENT ",,,94.5,,,63.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",176.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",85.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",26.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",89.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",80.33,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",26.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",56.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",25.3,176.3,
"US OB Transvaginal",1876817,CDM,402,RC,76817,HCPCS,"OUTPATIENT ",,,445.05,,,298.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",124.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",124.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",199.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",400.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",125.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",124.61,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",422.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",378.29,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",124.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges",267.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",121.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.14,422.8,
"US Paracentesis",1849080,CDM,361,RC,49083,HCPCS,"OUTPATIENT ",,,747,,,500.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",209.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",199.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",209.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",672.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",199.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",209.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",709.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",634.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",209.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",448.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",204.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",199.97,709.65,
"US Pelvic Non OB Comp",1876856,CDM,402,RC,76856,HCPCS,"OUTPATIENT ",,,843.75,,,565.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",236.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",225.87,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",236.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",242.09,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",759.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",225.87,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",236.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",801.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",717.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",236.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",506.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",230.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",225.87,801.56,
"US Pelvic Non OB Ltd",1876857,CDM,402,RC,76857,HCPCS,"OUTPATIENT ",,,617.25,,,413.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",184.58,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",555.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",586.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.66,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.24,586.39,
"US Retroperitoneal Complete",1876770,CDM,402,RC,76770,HCPCS,"OUTPATIENT ",,,1047.5,,,701.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",257.73,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",942.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,555.04,246.34,555.04,"1 through 10",other,"not separately reimbursment",296.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",257.73,995.13,
"US Retroperitoneal Limited",1876775,CDM,402,RC,76775,HCPCS,"OUTPATIENT ",,,930.6,,,623.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",260.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",249.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",260.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",211.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",837.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",249.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",260.57,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",884.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",791.01,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",260.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges",558.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",254.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",211.43,884.07,
"US Scrotum (Contents)",1876870,CDM,402,RC,76870,HCPCS,"OUTPATIENT ",,,499.05,,,334.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",139.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",133.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",139.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",241.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",449.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,89.31,89.31,89.31,"1 through 10",other,"not separately reimbursment",141.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",133.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",139.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",474.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",424.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",139.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",299.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",136.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",133.6,474.1,
"US Spinal Canal",1876800,CDM,402,RC,76800,HCPCS,"OUTPATIENT ",,,455,,,304.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",127.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",127.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",257.36,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",409.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",127.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",432.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",386.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",127.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",273,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",124.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121.8,432.25,
"US Thoracentesis",1832421,CDM,330,RC,32555,HCPCS,"OUTPATIENT ",,,1656,,,1109.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",443.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1490.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",443.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",463.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1573.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1407.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",993.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",452.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",443.31,1573.2,
"US Transvaginal Non-OB",1876830,CDM,402,RC,76830,HCPCS,"OUTPATIENT ",,,403.2,,,270.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",147.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",362.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",383.04,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",342.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",241.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.94,383.04,
"US Upper Ext Arterial Duplex Bilateral",1893930,CDM,921,RC,93930,HCPCS,"OUTPATIENT ",,,1060,,,710.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",954,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",299.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",296.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.76,1007,
"US Upper Ext Arterial Duplex Left",1893932,CDM,921,RC,93931,HCPCS,"OUTPATIENT ",,,956.67,,,640.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",267.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",256.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",267.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",861,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",270.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",256.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",267.87,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",908.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",813.17,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",267.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges",574,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",261.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",256.1,908.84,
"US Upper Ext Arterial Duplex Right",1893931,CDM,921,RC,93931,HCPCS,"OUTPATIENT ",,,956.67,,,640.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",267.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",256.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",267.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",861,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",270.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",256.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",267.87,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",908.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",813.17,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",267.87,28,,,,,0,"percent of total billed charges ","28% of total billed charges",574,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",261.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",256.1,908.84,
"US Upper Ext Venous Duplex Bilateral",1893970,CDM,921,RC,93970,HCPCS,"OUTPATIENT ",,,2205,,,1477.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",617.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",590.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",617.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1984.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",623.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",590.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",617.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2094.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1874.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",617.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1323,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",602.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",590.28,2094.75,
"US Upper Ext Venous Duplex Left",1893972,CDM,921,RC,93971,HCPCS,"OUTPATIENT ",,,3035.5,,,2033.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2731.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,813.69,513.15,813.69,"1 through 10",other,"not separately reimbursment",858.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",812.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",849.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2883.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2580.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1821.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",829,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",812.6,2883.73,
"US Upper Ext Venous Duplex Right",1893971,CDM,921,RC,93971,HCPCS,"OUTPATIENT ",,,3035.5,,,2033.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2731.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,813.69,513.15,813.69,"1 through 10",other,"not separately reimbursment",858.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",812.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",849.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2883.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2580.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",849.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1821.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",829,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",812.6,2883.73,
"Vaginal hysterectomy, for uterus 250 g or less, with removal of tube(s), and/or ovary(s) 58262",658262,CDM,360,RC,58262,HCPCS,"OUTPATIENT ",,,2675,,,1792.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",749,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",716.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",749,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2407.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",756.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",716.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",749,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2541.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2273.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",749,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1605,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",730.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",716.1,2541.25,
"Valproic Acid",2280164,CDM,301,RC,80164,HCPCS,"OUTPATIENT ",,,52,,,34.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",46.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",49.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",44.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",31.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.27,49.4,
"Valproic Acid (Depakote)(R),S LC",2280164,CDM,301,RC,80164,HCPCS,"OUTPATIENT ",,,52,,,34.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",46.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",49.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",44.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",31.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.27,49.4,
"Valproic Acid Lvl",2280164,CDM,301,RC,80164,HCPCS,"OUTPATIENT ",,,52,,,34.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",46.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",14.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",49.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",44.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",14.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",31.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.27,49.4,
"Vancomycin Level",2280202,CDM,301,RC,80202,HCPCS,"OUTPATIENT ",,,55.5,,,37.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",49.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",47.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.27,52.73,
"Vancomycin Level Peak",2270202,CDM,301,RC,80202,HCPCS,"OUTPATIENT ",,,55.5,,,37.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",49.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",201.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",47.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.27,201.66,
"Vancomycin Level Trough",2260202,CDM,301,RC,80202,HCPCS,"OUTPATIENT ",,,55.5,,,37.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",49.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",201.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",47.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.27,201.66,
"Vancomycin Lvl Peak",2270202,CDM,301,RC,80202,HCPCS,"OUTPATIENT ",,,55.5,,,37.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",49.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",72.1,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",47.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.27,72.1,
"Vancomycin Lvl Trough",2260202,CDM,301,RC,80202,HCPCS,"OUTPATIENT ",,,55.5,,,37.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",49.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",53.36,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.27,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",15.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",47.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.56,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",14.27,53.36,
"Vanillylmandelic Acid, 24-Hr U LC",2284585,CDM,301,RC,84585,HCPCS,"OUTPATIENT ",,,80.16,,,53.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",72.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",148.34,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.49,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",22.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",76.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.88,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",68.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",48.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.88,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",19.49,148.34,
"Varicella Zoster Cult Rapid LC",22186058,CDM,300,RC,87254,HCPCS,"OUTPATIENT ",,,60,,,40.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.15,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",16.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",16.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.27,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.15,57,
"Varicella-Zoster Ab, IgM LC",2276787,CDM,302,RC,86787,HCPCS,"OUTPATIENT ",,,191.17,,,128.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",172.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",181.61,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",162.49,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.2,181.61,
"Varicella-Zoster Ab, IgM Qualitative LC",2276787,CDM,302,RC,86787,HCPCS,"OUTPATIENT ",,,191.17,,,128.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",172.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",181.61,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",162.49,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.2,181.61,
"Varicella-Zoster V Ab, IgG LC",2286787,CDM,302,RC,86787,HCPCS,"OUTPATIENT ",,,191.17,,,128.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.71,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",172.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",22.28,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",181.61,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",162.49,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16.52,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",16.2,181.61,
"VBG Puncture Add-On",2236415,CDM,300,RC,36415,HCPCS,"OUTPATIENT ",,,8.45,,,5.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",7.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,8.37,7.78,8.45,"1 through 10",other,"not separately reimbursment",2.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.26,8.03,
"VGCC Antibody LC",22140640,CDM,300,RC,86596,HCPCS,"OUTPATIENT ",,,40,,,26.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.72,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",15.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.2,38,
"VIP, Plasma LC",2284586,CDM,300,RC,84586,HCPCS,"OUTPATIENT ",,,648,,,434.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",44.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",583.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",25.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",183.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",44.43,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",181.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",615.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",45.32,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",550.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",181.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",388.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",45.32,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",25.66,615.6,
"Viral Culture, General LC",2287252,CDM,306,RC,87252,HCPCS,"OUTPATIENT ",,,167.52,,,112.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",150.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.8,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",159.14,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",28.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",142.39,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",100.51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.36,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,159.14,
"Viscosity, Serum LC",2285810,CDM,301,RC,85810,HCPCS,"OUTPATIENT ",,,31.47,,,21.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.04,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",28.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.69,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.98,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",26.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.98,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.81,29.9,
"Vitamin A LC",22142004,CDM,300,RC,84590,HCPCS,"OUTPATIENT ",,,35.52,,,23.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.58,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",31.97,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.58,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",33.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",30.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.95,33.74,
"Vitamin A, Serum LC",2284590,CDM,300,RC,84590,HCPCS,"OUTPATIENT ",,,35.52,,,23.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.58,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",31.97,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.58,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",9.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",33.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",30.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.87,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",9.95,33.74,
"Vitamin B1 (Thiamine), Blood LC",2274425,CDM,301,RC,84425,HCPCS,"OUTPATIENT ",,,222.83,,,149.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.19,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",200.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",26.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",62.39,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",211.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",27.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",189.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges",133.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",27.23,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,211.69,
"Vitamin B12 LC",2282607,CDM,301,RC,82607,HCPCS,"OUTPATIENT ",,,245.5,,,164.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",220.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,240.59,240.59,243.54,"1 through 10",other,"not separately reimbursment",69.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",68.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",208.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,233.23,
"Vitamin B12 Level",2282607,CDM,301,RC,82607,HCPCS,"OUTPATIENT ",,,245.5,,,164.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.72,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",220.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",15.68,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,240.59,240.59,243.54,"1 through 10",other,"not separately reimbursment",69.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",18.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",68.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",19.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",208.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",15.68,233.23,
"Vitamin B6, Plasma LC",2284207,CDM,301,RC,84207,HCPCS,"OUTPATIENT ",,,166.08,,,111.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.33,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",149.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",114.06,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.33,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",157.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",36.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",141.17,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",99.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.04,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",35.33,157.78,
"Vitamin C LC",2282180,CDM,301,RC,82180,HCPCS,"OUTPATIENT ",,,82,,,54.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.11,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.14,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",73.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",110.44,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.11,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",22.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",77.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",69.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",49.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.33,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",11.11,110.44,
"Vitamin D 25 Hydroxy Level",2282306,CDM,300,RC,82306,HCPCS,"OUTPATIENT ",,,286.5,,,191.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",80.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",37.22,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",80.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",257.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",26.5,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,204.28,132.45,216.09,"1 through 10",other,"not separately reimbursment",81.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",37.22,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",80.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",272.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",37.96,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",243.53,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",80.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",171.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",37.96,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",26.5,272.18,
"Vitamin D, 25-Hydroxy LC",2282306,CDM,300,RC,82306,HCPCS,"OUTPATIENT ",,,286.5,,,191.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",80.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",37.22,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",80.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",40.7,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",257.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",34.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,204.28,132.45,216.09,"1 through 10",other,"not separately reimbursment",81.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",37.22,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",80.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",272.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",37.96,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",243.53,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",80.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",171.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",37.96,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",34.61,272.18,
"Vitamin E LC",2284446,CDM,301,RC,84446,HCPCS,"OUTPATIENT ",,,124.45,,,83.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",112.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",34.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",118.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",105.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",74.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.83,118.23,
"Vitamin E(Alpha Tocopherol) LC",22070141,CDM,300,RC,84446,HCPCS,"OUTPATIENT ",,,124.45,,,83.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",112.01,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",34.61,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",34.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",118.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",18.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",105.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",74.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",18.19,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.83,118.23,
"Vitamin K1 LC",2284597,CDM,300,RC,84597,HCPCS,"OUTPATIENT ",,,495.36,,,331.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",138.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",138.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18.85,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",445.82,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",47.94,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",140.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.24,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",138.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",470.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",17.58,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",421.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",138.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",297.22,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.58,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",17.24,470.59,
"von Willebrand Factor (vWF) Ag LC",2285246,CDM,300,RC,85246,HCPCS,"OUTPATIENT ",,,116.16,,,77.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",32.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",32.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.54,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",104.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",23.58,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",28.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",32.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",110.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",29.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",98.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",32.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",69.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",29.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",23.58,110.35,
"vWF Activity LC",2285245,CDM,300,RC,85245,HCPCS,"OUTPATIENT ",,,965,,,646.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",270.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",28.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",270.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31.54,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",868.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",62.17,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",272.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",28.85,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",270.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",916.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",29.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",820.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",270.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",579,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",29.43,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",28.85,916.75,
"W001-IgE Ragweed, Short LC",22602463,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",28.02,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"W004-IgE Ragweed, False LC",22602965,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.19,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.19,86.93,
"W009-IgE Plantain, English LC",22602536,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.3,86.93,
"W010-IgE Lamb's Quarters LC",22602537,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.3,86.93,
"W012-IgE Goldenrod LC",22602969,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2.3,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.3,86.93,
"W013-IgE Cocklebur LC",22602970,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.07,86.93,
"W014-IgE Pigweed, Common LC",22602484,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.07,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.07,86.93,
"W018-IgE Sheep Sorrel LC",22602542,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",9.35,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",6.57,86.93,
"W020-IgE Nettle LC",22602973,CDM,302,RC,86003,HCPCS,"OUTPATIENT ",,,91.5,,,61.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",82.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",5.65,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,142.88,83.85,201.91,"1 through 10",other,"not separately reimbursment",25.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6.57,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",25.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",86.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",77.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",25.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",54.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6.7,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.65,86.93,
"Wet Mount",2287210,CDM,306,RC,87210,HCPCS,"OUTPATIENT ",,,37.5,,,25.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",33.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",6.22,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.36,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.47,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",5.36,35.63,
"Wheelchair Charge",4411965,CDM,430,RC,97542,HCPCS,"OUTPATIENT ",,,56,,,37.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",50.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",47.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.99,53.2,
"Wheelchair Management Charges",4601965,CDM,420,RC,97542,HCPCS,"OUTPATIENT ",,,56,,,37.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",50.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",53.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",47.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",33.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",15.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.99,53.2,
"Whirlpool Full Body Charge",4601540,CDM,420,RC,97022,HCPCS,"OUTPATIENT ",,,182,,,121.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",48.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",163.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",48.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",50.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",172.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",154.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",50.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",109.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",49.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",48.72,172.9,
"White Blood Cell Count",2285048,CDM,305,RC,85048,HCPCS,"OUTPATIENT ",,,41,,,27.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.49,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",36.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",26.73,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.2,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",11.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",34.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.26,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.2,38.95,
"White Blood Cells (WBC), Stool LC",2289055,CDM,306,RC,89055,HCPCS,"OUTPATIENT ",,,110,,,73.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",26.73,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.95,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",30.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",93.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.01,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.95,104.5,
"White Cell Count w/ Auto Diff",2285026,CDM,305,RC,85004,HCPCS,"OUTPATIENT ",,,69.84,,,46.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",19.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",19.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",62.86,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",133.94,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8.14,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",19.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",66.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",59.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",19.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",41.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8.3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",8.14,133.94,
"White Cell Count w/Man Diff",2285026,CDM,305,RC,85009,HCPCS,"OUTPATIENT ",,,20,,,13.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",133.94,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",4.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",17,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.76,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",4.67,133.94,
"Whole Blood Glucose POCT",2282962,CDM,301,RC,82962,HCPCS,"OUTPATIENT ",,,19.5,,,13.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",17.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,25.97,25.97,25.97,"1 through 10",other,"not separately reimbursment",5.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.94,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",5.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18.53,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",16.58,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.94,18.53,
"Wound Culture",2287070,CDM,301,RC,87070,HCPCS,"OUTPATIENT ",,,164.5,,,110.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",148.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.96,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.83,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",46.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",156.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",139.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",46.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.05,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.96,156.28,
"XM AHG Gel Interp",22286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
"XM AHG Tube Interp",2286922,CDM,302,RC,86922,HCPCS,"OUTPATIENT ",,,339.12,,,227.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",90.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",305.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",90.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.95,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",322.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",288.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.95,28,,,,,0,"percent of total billed charges ","28% of total billed charges",203.47,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",92.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",90.78,322.16,
"XR Abdomen 2 Views",1474010,CDM,320,RC,74019,HCPCS,"OUTPATIENT ",,,408.6,,,273.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",114.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",114.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",367.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",109.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",114.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",388.17,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",347.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",114.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",245.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",111.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",109.38,388.17,
"XR Abdomen KUB 1 View",1474000,CDM,320,RC,74018,HCPCS,"OUTPATIENT ",,,319.95,,,214.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",89.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",89.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",287.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,11.57,11.57,11.57,"1 through 10",other,"not separately reimbursment",90.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",85.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",89.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",303.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",271.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",89.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",191.97,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",87.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",85.65,303.95,
"XR Abdomen Series  Chest 1 View",1474022,CDM,320,RC,74022,HCPCS,"OUTPATIENT ",,,177.3,,,118.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",47.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",95.76,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",159.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",47.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",49.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",150.71,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",48.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",47.46,168.44,
"XR AC Joints Bilateral",1473050,CDM,320,RC,73050,HCPCS,"OUTPATIENT ",,,260.64,,,174.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",72.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",69.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",72.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",79.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",234.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",69.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",72.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",247.61,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",221.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",72.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",71.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",69.77,247.61,
"XR Ankle Complete 3+ Views Left",1473611,CDM,320,RC,73610,HCPCS,"OUTPATIENT ",,,330.3,,,221.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",313.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",280.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.08,313.79,
"XR Ankle Complete 3+ Views Right",1473610,CDM,320,RC,73610,HCPCS,"OUTPATIENT ",,,330.3,,,221.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",313.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",280.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.08,313.79,
"XR Arthrogram Ankle SI Left",1473615,CDM,322,RC,73615,HCPCS,"OUTPATIENT ",,,842,,,564.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",225.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.36,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",757.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",225.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",235.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",799.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",715.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",505.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207.36,799.9,
"XR Arthrogram Ankle SI Right",1473615,CDM,322,RC,73615,HCPCS,"OUTPATIENT ",,,842,,,564.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",225.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.36,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",757.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",225.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",235.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",799.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",715.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",505.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207.36,799.9,
"XR Arthrogram Elbow Left",1473085,CDM,322,RC,73085,HCPCS,"OUTPATIENT ",,,842,,,564.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",225.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",757.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",225.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",235.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",799.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",715.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",505.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.35,799.9,
"XR Arthrogram Elbow Right",1473085,CDM,322,RC,73085,HCPCS,"OUTPATIENT ",,,842,,,564.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",225.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.35,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",757.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",225.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",235.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",799.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",715.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",235.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",505.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",200.35,799.9,
"XR Arthrogram Hip Left",1473526,CDM,320,RC,73525,HCPCS,"OUTPATIENT ",,,973.23,,,652.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",272.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",260.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",272.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.36,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",875.91,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",260.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",272.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",924.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",827.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",272.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",583.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",265.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207.36,924.57,
"XR Arthrogram Hip Right",1473525,CDM,320,RC,73525,HCPCS,"OUTPATIENT ",,,973.23,,,652.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",272.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",260.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",272.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.36,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",875.91,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",260.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",272.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",924.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",827.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",272.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",583.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",265.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207.36,924.57,
"XR Arthrogram Knee Left",1473580,CDM,322,RC,73580,HCPCS,"OUTPATIENT ",,,404.16,,,270.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",108.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",256.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",363.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",108.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",113.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",383.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",343.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",242.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",108.19,383.95,
"XR Arthrogram Knee Right",1473580,CDM,322,RC,73580,HCPCS,"OUTPATIENT ",,,404.16,,,270.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",108.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",256.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",363.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",108.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",113.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",383.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",343.54,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",242.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",108.19,383.95,
"XR Arthrogram Shoulder Left",1473040,CDM,320,RC,73040,HCPCS,"OUTPATIENT ",,,1391.72,,,932.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",389.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",372.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",389.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.98,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1252.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",393.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",372.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",389.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1322.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1182.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",389.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",835.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",380.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207.98,1322.13,
"XR Arthrogram Shoulder Right",1473041,CDM,320,RC,73040,HCPCS,"OUTPATIENT ",,,1391.72,,,932.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",389.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",372.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",389.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.98,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1252.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",393.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",372.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",389.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1322.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1182.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",389.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",835.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",380.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",207.98,1322.13,
"XR Arthrogram Wrist Left",1473115,CDM,322,RC,73115,HCPCS,"OUTPATIENT ",,,662.09,,,443.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",185.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",177.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",185.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",218.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",595.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",187.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",177.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",185.39,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",628.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",562.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",185.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges",397.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",180.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",177.24,628.99,
"XR Arthrogram Wrist Right",1473115,CDM,322,RC,73115,HCPCS,"OUTPATIENT ",,,662.09,,,443.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",185.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",177.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",185.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",218.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",595.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",187.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",177.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",185.39,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",628.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",562.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",185.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges",397.25,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",180.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",177.24,628.99,
"XR Barium Enema Complete",1474270,CDM,320,RC,74270,HCPCS,"OUTPATIENT ",,,1271,,,851.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",355.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",340.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",355.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",307.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1143.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",359.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",340.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",355.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1207.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1080.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",355.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",762.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",347.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",307.57,1207.45,
"XR Barium Enema w/ Air Complete",1474280,CDM,320,RC,74280,HCPCS,"OUTPATIENT ",,,734.4,,,492.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",205.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",196.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",205.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",429.87,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",660.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",207.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",196.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",205.63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",697.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",624.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",205.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",440.64,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",200.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",196.6,697.68,
"XR Biopsy Liver",1447000,CDM,361,RC,77002,HCPCS,"OUTPATIENT ",,,1329,,,890.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",355.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",153.32,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1196.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,7.78,7.78,7.78,"1 through 10",other,"not separately reimbursment",375.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",355.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",372.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1262.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1129.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",797.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",153.32,1262.55,
"XR Bone Age Studies",1477072,CDM,320,RC,77072,HCPCS,"OUTPATIENT ",,,276.7,,,185.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",77.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",74.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",77.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",45.88,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",249.03,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",74.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",77.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",262.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",235.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",77.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",166.02,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",75.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",45.88,262.87,
"XR Bone Length Studies Scanograms",1477073,CDM,320,RC,77073,HCPCS,"OUTPATIENT ",,,414.7,,,277.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",116.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",111.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",116.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",75.75,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",373.23,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",111.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",116.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",393.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",352.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",116.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",248.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",113.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",75.75,393.97,
"XR Calcaneus Left",1473651,CDM,320,RC,73650,HCPCS,"OUTPATIENT ",,,471.9,,,316.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",424.71,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",56.47,448.31,
"XR Calcaneus Right",1473650,CDM,320,RC,73650,HCPCS,"OUTPATIENT ",,,471.9,,,316.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",424.71,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",56.47,448.31,
"XR Chest 1 View",1471010,CDM,324,RC,71045,HCPCS,"OUTPATIENT ",,,711,,,476.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",639.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,357.21,51.78,469.48,"1 through 10",other,"not separately reimbursment",201.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",199.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",675.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",604.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",426.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",194.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.33,675.45,
"XR Chest 2 Views",1471020,CDM,324,RC,71046,HCPCS,"OUTPATIENT ",,,845.77,,,566.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",236.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",226.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",236.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",761.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,157.08,107.38,811.23,"1 through 10",other,"not separately reimbursment",239.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",226.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",236.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",803.48,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",718.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",236.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",507.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",230.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",226.41,803.48,
"XR Chest 4+ Views",1471022,CDM,320,RC,71048,HCPCS,"OUTPATIENT ",,,677.44,,,453.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",189.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",181.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",189.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",609.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",191.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",181.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",189.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",643.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",575.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",189.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",406.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",185.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",181.35,643.57,
"XR Clavicle Left",1473001,CDM,320,RC,73000,HCPCS,"OUTPATIENT ",,,517.54,,,346.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.12,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",465.79,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",146.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",491.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",439.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",310.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",141.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.12,491.66,
"XR Clavicle Right",1473000,CDM,320,RC,73000,HCPCS,"OUTPATIENT ",,,575.05,,,385.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",161.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",153.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",161.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.12,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",517.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",162.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",153.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",161.01,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",546.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",488.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",161.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges",345.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",157.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.12,546.3,
"XR Elbow 2 Views Left",1473071,CDM,320,RC,73070,HCPCS,"OUTPATIENT ",,,441.87,,,296.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",123.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",118.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",123.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",397.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,433.03,433.03,433.03,"1 through 10",other,"not separately reimbursment",124.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",118.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",123.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",419.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",375.59,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",123.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",265.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",120.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",56.41,419.78,
"XR Elbow 2 Views Right",1473070,CDM,320,RC,73070,HCPCS,"OUTPATIENT ",,,441.87,,,296.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",123.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",118.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",123.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.41,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",397.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,433.03,433.03,433.03,"1 through 10",other,"not separately reimbursment",124.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",118.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",123.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",419.78,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",375.59,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",123.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",265.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",120.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",56.41,419.78,
"XR Elbow Complete 3+ Views Left",1473081,CDM,320,RC,73080,HCPCS,"OUTPATIENT ",,,330.3,,,221.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,499.46,495.42,503.49,"1 through 10",other,"not separately reimbursment",93.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",313.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",280.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.08,313.79,
"XR Elbow Complete 3+ Views Right",1473080,CDM,320,RC,73080,HCPCS,"OUTPATIENT ",,,330.3,,,221.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,499.46,495.42,503.49,"1 through 10",other,"not separately reimbursment",93.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",313.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",280.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.08,313.79,
"XR Esophagus",1474220,CDM,320,RC,74220,HCPCS,"OUTPATIENT ",,,1586.01,,,1062.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",444.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",424.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",444.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",178.8,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1427.41,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,164.53,164.53,164.53,"1 through 10",other,"not separately reimbursment",448.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",424.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",444.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1506.71,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1348.11,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",444.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",951.61,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",433.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",178.8,1506.71,
"XR Facial Bones < 3 Views",1470140,CDM,320,RC,70140,HCPCS,"OUTPATIENT ",,,124.8,,,83.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",34.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",33.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",34.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",112.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",33.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",34.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",118.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",106.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",34.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",74.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",34.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",33.41,118.56,
"XR Facial Bones 3+ Views",1470150,CDM,320,RC,70150,HCPCS,"OUTPATIENT ",,,841.48,,,563.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",235.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",225.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",235.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",83.89,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",757.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",237.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",225.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",235.61,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",799.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",715.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",235.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges",504.89,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",83.89,799.41,
"XR Femur 2 Views Left",1473551,CDM,320,RC,73552,HCPCS,"OUTPATIENT ",,,817.5,,,547.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",228.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",218.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",228.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",735.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,148.95,93.88,617.01,"1 through 10",other,"not separately reimbursment",231.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",218.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",228.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",776.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",694.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",228.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",490.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",223.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",218.84,776.63,
"XR Femur 2 Views Right",1473550,CDM,320,RC,73552,HCPCS,"OUTPATIENT ",,,817.5,,,547.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",228.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",218.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",228.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",735.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,148.95,93.88,617.01,"1 through 10",other,"not separately reimbursment",231.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",218.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",228.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",776.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",694.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",228.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",490.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",223.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",218.84,776.63,
"XR Finger(s) 2 Views Left",1473141,CDM,320,RC,73140,HCPCS,"OUTPATIENT ",,,274.05,,,183.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",76.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",73.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",76.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",246.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",73.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",76.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",260.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",232.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",76.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",164.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",74.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.44,260.35,
"XR Finger(s) 2 Views Right",1473140,CDM,320,RC,73140,HCPCS,"OUTPATIENT ",,,274.05,,,183.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",76.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",73.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",76.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",246.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",73.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",76.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",260.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",232.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",76.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",164.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",74.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.44,260.35,
"XR Finger(s) 2+ Views Right",1473140,CDM,320,RC,73140,HCPCS,"OUTPATIENT ",,,304.5,,,204.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",81.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",274.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",81.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",289.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",258.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",182.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.44,289.28,
"XR Fluoro Guidance Needle Loc Spine",1477003,CDM,320,RC,77003,HCPCS,"OUTPATIENT ",,,435.84,,,292.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",122.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",116.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",122.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",183.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",392.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",116.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",122.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",414.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",370.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",122.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",261.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",119.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",116.67,414.05,
"XR Fluoro Guidance Needle Loc Spine",1477003,CDM,320,RC,77003,HCPCS,"OUTPATIENT ",,,435.84,,,292.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",122.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",116.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",122.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",183.62,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",392.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",116.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",122.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",414.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",370.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",122.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",261.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",119.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",116.67,414.05,
"XR Fluoro Guidance Needle Placement",1477002,CDM,320,RC,77002,HCPCS,"OUTPATIENT ",,,1329,,,890.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",355.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",153.32,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1196.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,7.78,7.78,7.78,"1 through 10",other,"not separately reimbursment",375.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",355.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",372.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1262.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1129.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",797.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",153.32,1262.55,
"XR Fluoro Needle Placement",1477002,CDM,320,RC,77002,HCPCS,"OUTPATIENT ",,,1196.1,,,801.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",334.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",320.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",334.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",153.32,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1076.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,7.78,7.78,7.78,"1 through 10",other,"not separately reimbursment",338.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",320.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",334.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1136.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1016.69,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",334.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",717.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",326.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",153.32,1136.3,
"XR Fluoro Sinus Tract Injection",1420501,CDM,360,RC,20501,HCPCS,"OUTPATIENT ",,,934,,,625.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",261.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",250.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",261.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",840.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",264.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",250.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",261.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",887.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",793.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",261.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",560.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",255.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",250.03,887.3,
"XR Fluoroscopy Under 1 Hour",1476000,CDM,320,RC,76000,HCPCS,"OUTPATIENT ",,,1507.05,,,1009.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",421.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",403.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",421.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",100.4,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1356.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,103.77,88.92,162.93,"1 through 10",other,"not separately reimbursment",426.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",403.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",421.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1431.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1280.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",421.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",904.23,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",411.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",100.4,1431.7,
"XR Foot 2 Views Left",1473621,CDM,320,RC,73620,HCPCS,"OUTPATIENT ",,,598.5,,,401,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",167.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",160.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",167.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",538.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",160.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",167.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",568.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",508.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",167.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",359.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",163.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.56,568.58,
"XR Foot 2 Views Right",1473620,CDM,320,RC,73620,HCPCS,"OUTPATIENT ",,,598.5,,,401,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",167.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",160.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",167.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",538.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",160.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",167.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",568.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",508.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",167.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",359.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",163.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.56,568.58,
"XR Foot Complete 3+ Views Left",1473631,CDM,320,RC,73630,HCPCS,"OUTPATIENT ",,,330.3,,,221.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.28,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,295.36,295.36,295.36,"1 through 10",other,"not separately reimbursment",93.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",313.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",280.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.28,313.79,
"XR Foot Complete 3+ Views Right",1473630,CDM,320,RC,73630,HCPCS,"OUTPATIENT ",,,330.3,,,221.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.28,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,295.36,295.36,295.36,"1 through 10",other,"not separately reimbursment",93.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",313.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",280.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.28,313.79,
"XR Forearm 2 Views Left",1473091,CDM,320,RC,73090,HCPCS,"OUTPATIENT ",,,133.2,,,89.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",119.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,199.43,199.43,199.43,"1 through 10",other,"not separately reimbursment",37.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",113.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.66,126.54,
"XR Forearm 2 Views Right",1473090,CDM,320,RC,73090,HCPCS,"OUTPATIENT ",,,133.2,,,89.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",37.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",37.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",119.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,199.43,199.43,199.43,"1 through 10",other,"not separately reimbursment",37.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",37.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",126.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",113.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",37.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",79.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",36.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.66,126.54,
"XR Foreign Body Localization Child 1 Vw",1476010,CDM,320,RC,76010,HCPCS,"OUTPATIENT ",,,217,,,145.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",60.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",60.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.81,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",195.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",61.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",58.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",60.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",206.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",184.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",60.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",130.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",59.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.81,206.15,
"XR Hand 2 Views Left",1473121,CDM,320,RC,73120,HCPCS,"OUTPATIENT ",,,265.85,,,178.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",239.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,289.48,289.48,289.48,"1 through 10",other,"not separately reimbursment",75.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",225.97,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.56,252.56,
"XR Hand 2 Views Right",1473119,CDM,320,RC,73120,HCPCS,"OUTPATIENT ",,,265.85,,,178.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.56,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",239.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,289.48,289.48,289.48,"1 through 10",other,"not separately reimbursment",75.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",225.97,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.51,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.56,252.56,
"XR Hand Complete 3+ Views Left",1473131,CDM,320,RC,73130,HCPCS,"OUTPATIENT ",,,443.7,,,297.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",124.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",118.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",124.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",64.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",399.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",125.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",118.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",124.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",421.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",377.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",124.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",266.22,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",121.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",64.17,421.52,
"XR Hand Complete 3+ Views Right",1473130,CDM,320,RC,73130,HCPCS,"OUTPATIENT ",,,443.7,,,297.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",124.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",118.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",124.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",64.17,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",399.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",125.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",118.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",124.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",421.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",377.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",124.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",266.22,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",121.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",64.17,421.52,
"XR Hip 1 View Left",1473501,CDM,320,RC,73501,HCPCS,"OUTPATIENT ",,,237.6,,,159.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",213.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",63.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",66.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",225.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",201.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",142.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",64.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.61,225.72,
"XR Hip 1 View Right",1473500,CDM,320,RC,73501,HCPCS,"OUTPATIENT ",,,237.6,,,159.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",66.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",66.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",213.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",63.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",66.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",225.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",201.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",66.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",142.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",64.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.61,225.72,
"XR Hip 2-3 Views Left",1473511,CDM,320,RC,73502,HCPCS,"OUTPATIENT ",,,865.8,,,580.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",242.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",231.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",242.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",779.22,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,357.47,114.94,705.96,"1 through 10",other,"not separately reimbursment",244.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",231.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",242.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",822.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",735.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",242.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",519.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",236.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",231.77,822.51,
"XR Hip 2-3 Views Right",1473510,CDM,320,RC,73502,HCPCS,"OUTPATIENT ",,,865.8,,,580.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",242.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",231.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",242.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",779.22,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,357.47,114.94,705.96,"1 through 10",other,"not separately reimbursment",244.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",231.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",242.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",822.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",735.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",242.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",519.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",236.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",231.77,822.51,
"XR Humerus Left",1473061,CDM,320,RC,73060,HCPCS,"OUTPATIENT ",,,932.5,,,624.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",261.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",249.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",261.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.18,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",839.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,708.05,708.05,708.05,"1 through 10",other,"not separately reimbursment",263.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",249.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",261.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",885.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",792.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",261.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",559.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",254.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.18,885.88,
"XR Humerus Right",1473060,CDM,320,RC,73060,HCPCS,"OUTPATIENT ",,,932.5,,,624.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",261.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",249.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",261.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.18,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",839.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,708.05,708.05,708.05,"1 through 10",other,"not separately reimbursment",263.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",249.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",261.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",885.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",792.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",261.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",559.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",254.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.18,885.88,
"XR IVP",1474410,CDM,320,RC,74410,HCPCS,"OUTPATIENT ",,,980.98,,,657.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",217.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",882.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",931.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",833.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",588.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",217.78,931.93,
"XR Joint/Bursa Major Arthr/Asp/Inj Left",2020610,CDM,360,RC,20610,HCPCS,"OUTPATIENT ",,,250,,,167.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.93,237.5,
"XR Joint/Bursa Major Arthr/Asp/Inj Right",2020610,CDM,360,RC,20610,HCPCS,"OUTPATIENT ",,,250,,,167.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",225,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",237.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",212.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70,28,,,,,0,"percent of total billed charges ","28% of total billed charges",150,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.93,237.5,
"XR Knee 1 or 2 Views Left",1473561,CDM,320,RC,73560,HCPCS,"OUTPATIENT ",,,716.4,,,479.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",200.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",191.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",200.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.67,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",644.76,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,226.22,226.22,226.22,"1 through 10",other,"not separately reimbursment",202.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",191.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",200.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",680.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",608.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",200.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",429.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",195.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.67,680.58,
"XR Knee 1 or 2 Views Right",1473560,CDM,320,RC,73560,HCPCS,"OUTPATIENT ",,,716.4,,,479.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",200.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",191.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",200.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.67,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",644.76,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,226.22,226.22,226.22,"1 through 10",other,"not separately reimbursment",202.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",191.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",200.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",680.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",608.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",200.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",429.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",195.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.67,680.58,
"XR Knee 1 View Standing AP Bilateral",1473559,CDM,320,RC,73565,HCPCS,"OUTPATIENT ",,,218.79,,,146.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",61.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",61.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",196.91,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",61.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",58.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",61.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",207.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",185.97,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",61.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",131.27,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",59.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",58.57,207.85,
"XR Knee 3 Views Left",1473563,CDM,320,RC,73562,HCPCS,"OUTPATIENT ",,,1026.5,,,687.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",287.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",287.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",74.46,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",923.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,388.62,123.12,1005.97,"1 through 10",other,"not separately reimbursment",290.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",287.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",975.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",872.53,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",287.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",615.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",280.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",74.46,975.18,
"XR Knee 3 Views Right",1473562,CDM,320,RC,73562,HCPCS,"OUTPATIENT ",,,1026.5,,,687.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",287.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",287.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",74.46,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",923.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,388.62,123.12,1005.97,"1 through 10",other,"not separately reimbursment",290.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",287.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",975.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",872.53,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",287.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",615.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",280.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",74.46,975.18,
"XR Lower Extremity Infant (0-1yr) Left",1473593,CDM,320,RC,73592,HCPCS,"OUTPATIENT ",,,249,,,166.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",224.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",236.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",211.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",55.2,236.55,
"XR Lower Extremity Infant (0-1yr) Right",1473592,CDM,320,RC,73592,HCPCS,"OUTPATIENT ",,,249,,,166.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",55.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",224.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",236.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",211.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",55.2,236.55,
"XR Mandible Complete 4+ Views",1470110,CDM,320,RC,70110,HCPCS,"OUTPATIENT ",,,296.64,,,198.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",83.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",79.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",83.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",78.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",266.98,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",83.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",79.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",83.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",281.81,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",252.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",83.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",177.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",78.1,281.81,
"XR Mandible Less Than 4 Views",1470100,CDM,320,RC,70100,HCPCS,"OUTPATIENT ",,,221,,,148.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",61.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",61.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",68.06,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",198.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",62.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",61.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",209.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",187.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",61.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",132.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",60.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59.16,209.95,
"XR Mastoids Complete",1370130,CDM,320,RC,70130,HCPCS,"OUTPATIENT ",,,241,,,161.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",67.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",64.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",67.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",115.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",216.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",68.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",64.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",67.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",228.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",204.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",67.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",144.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",65.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",64.52,228.95,
"XR Myelogram Cervical Spine",1472240,CDM,361,RC,62302,HCPCS,"OUTPATIENT ",,,4794.79,,,3212.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1342.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1283.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1342.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4315.31,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1355.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1283.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1342.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4555.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4075.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1342.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2876.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1309.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1283.57,4555.05,
"XR Myelogram Injection",1472270,CDM,361,RC,62305,HCPCS,"OUTPATIENT ",,,3273,,,2192.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",916.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",876.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",916.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2945.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",925.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",876.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",916.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3109.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2782.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",916.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1963.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",893.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",876.18,3109.35,
"XR Myelogram Lumbosacral Spine",1472265,CDM,320,RC,72265,HCPCS,"OUTPATIENT ",,,2086.37,,,1397.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",584.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",558.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",584.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",246.94,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1877.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",590.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",558.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",584.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1982.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1773.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",584.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1251.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",569.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",246.94,1982.05,
"XR Myelogram Thoracic Spine",1472255,CDM,320,RC,72255,HCPCS,"OUTPATIENT ",,,1450,,,971.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",406,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",388.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",406,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",240.53,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1305,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",410.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",388.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",406,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1377.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1232.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",406,28,,,,,0,"percent of total billed charges ","28% of total billed charges",870,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",396,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",240.53,1377.5,
"XR Nasal Bones 3+ Views",1470160,CDM,320,RC,70160,HCPCS,"OUTPATIENT ",,,554.17,,,371.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",155.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",148.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",155.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.08,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",498.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",148.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",155.17,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",526.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",471.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",155.17,28,,,,,0,"percent of total billed charges ","28% of total billed charges",332.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",151.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.08,526.46,
"XR Neck Soft Tissue",1470360,CDM,320,RC,70360,HCPCS,"OUTPATIENT ",,,330.3,,,221.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",88.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",297.27,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",88.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",92.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",313.79,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",280.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",92.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",198.18,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",90.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.64,313.79,
"XR Optic Foramina",1470190,CDM,320,RC,70190,HCPCS,"OUTPATIENT ",,,196,,,131.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.45,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",176.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",186.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",166.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",117.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.47,186.2,
"XR Orbits Complete",1470200,CDM,320,RC,70200,HCPCS,"OUTPATIENT ",,,745.26,,,499.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",208.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",199.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",208.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",85.95,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",670.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",210.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",199.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",208.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",708,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",633.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",208.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",447.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",203.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",85.95,708,
"XR Osseous Survey Complete",1477075,CDM,320,RC,77075,HCPCS,"OUTPATIENT ",,,460.8,,,308.74,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",129.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",129.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",206.07,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",414.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",129.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",129.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.36,437.76,
"XR Osseous Survey Infant",1477076,CDM,320,RC,77076,HCPCS,"OUTPATIENT ",,,603,,,404.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",168.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",161.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",168.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",207.23,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",542.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",170.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",161.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",168.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",572.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",512.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",168.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",361.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",164.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",161.42,572.85,
"XR Osseous Survey Limited",1477074,CDM,320,RC,77074,HCPCS,"OUTPATIENT ",,,960,,,643.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",268.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",256.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",268.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",136.78,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",864,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",271.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",256.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",268.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",912,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",816,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",268.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",576,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",262.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",136.78,912,
"XR Peg Tube Placement",1449465,CDM,361,RC,49465,HCPCS,"OUTPATIENT ",,,460.1,,,308.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",414.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.17,437.1,
"XR Pelvis 1 or 2 Views",1472170,CDM,320,RC,72170,HCPCS,"OUTPATIENT ",,,971.02,,,650.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",271.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",259.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",271.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.22,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",873.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,647.78,647.78,647.78,"1 through 10",other,"not separately reimbursment",274.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",259.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",271.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",922.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",825.37,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",271.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",582.61,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",265.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.22,922.47,
"XR Pharynx or Cervical Esophagus",1474210,CDM,320,RC,74210,HCPCS,"OUTPATIENT ",,,414,,,277.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",115.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",110.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",115.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",152.61,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",372.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",110.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",115.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",393.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",351.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",115.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",248.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",113.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",110.83,393.3,
"XR Ribs 2 Views Left",1471100,CDM,324,RC,71100,HCPCS,"OUTPATIENT ",,,831.75,,,557.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",232.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",222.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",232.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",748.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",235.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",222.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",232.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",790.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",706.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",232.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",499.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",227.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.9,790.16,
"XR Ribs 2 Views Right",1471100,CDM,324,RC,71100,HCPCS,"OUTPATIENT ",,,831.75,,,557.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",232.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",222.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",232.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.9,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",748.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",235.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",222.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",232.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",790.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",706.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",232.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",499.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",227.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.9,790.16,
"XR Ribs 3 Views Bilateral",1471110,CDM,324,RC,71110,HCPCS,"OUTPATIENT ",,,233.76,,,156.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.14,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",210.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",222.07,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.58,222.07,
"XR Ribs 3 Views Left",1471102,CDM,320,RC,71101,HCPCS,"OUTPATIENT ",,,356.28,,,238.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",99.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",95.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",99.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",77.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",320.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",95.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",99.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",338.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",302.84,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",99.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",213.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",97.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",77.6,338.47,
"XR Ribs 3 Views Right",1471101,CDM,320,RC,71101,HCPCS,"OUTPATIENT ",,,356.28,,,238.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",99.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",95.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",99.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",77.6,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",320.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",95.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",99.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",338.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",302.84,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",99.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",213.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",97.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",77.6,338.47,
"XR Ribs w/ PA Chest Bilateral",1471111,CDM,320,RC,71111,HCPCS,"OUTPATIENT ",,,266,,,178.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",104.67,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",239.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",226.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",71.21,252.7,
"XR Ribs w/ PA Chest Left",1471111,CDM,320,RC,71111,HCPCS,"OUTPATIENT ",,,399,,,267.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",111.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",111.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",104.67,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",359.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",112.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",111.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",379.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",339.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",111.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",239.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",104.67,379.05,
"XR Ribs w/ PA Chest Right",1471111,CDM,320,RC,71111,HCPCS,"OUTPATIENT ",,,399,,,267.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",111.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",106.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",111.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",104.67,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",359.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",112.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",106.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",111.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",379.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",339.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",111.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",239.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",108.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",104.67,379.05,
"XR Sacroiliac Joint Injection Bilateral",1427096LR,CDM,320,RC,27096,HCPCS,"OUTPATIENT ",,,796,,,533.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",213.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",716.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",225.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",213.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",222.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",756.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",676.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",477.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",217.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",213.09,756.2,
"XR Sacroiliac Joint Injection Left",1427096L,CDM,320,RC,27096,HCPCS,"OUTPATIENT ",,,796,,,533.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",213.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",716.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",225.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",213.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",222.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",756.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",676.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",477.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",217.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",213.09,756.2,
"XR Sacroiliac Joint Injection Right",1427096R,CDM,320,RC,27096,HCPCS,"OUTPATIENT ",,,796,,,533.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",213.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",716.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",225.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",213.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",222.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",756.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",676.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",477.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",217.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",213.09,756.2,
"XR Sacroiliac Joints 1 or 2 Views",1472202,CDM,320,RC,72202,HCPCS,"OUTPATIENT ",,,632.89,,,424.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",177.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",169.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",177.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",68.14,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",569.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",169.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",177.21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",601.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",537.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",177.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",379.73,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",172.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",68.14,601.25,
"XR Sacrum/Coccyx 2+ Views",1472220,CDM,320,RC,72220,HCPCS,"OUTPATIENT ",,,459.75,,,308.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",57.18,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",413.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.73,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",436.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",390.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.73,28,,,,,0,"percent of total billed charges ","28% of total billed charges",275.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",57.18,436.76,
"XR Scapula Left",1473011,CDM,320,RC,73010,HCPCS,"OUTPATIENT ",,,568.5,,,380.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",159.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",152.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",159.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",511.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",152.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",159.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",540.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",483.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",159.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",341.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",155.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.59,540.08,
"XR Scapula Right",1473010,CDM,320,RC,73010,HCPCS,"OUTPATIENT ",,,568.5,,,380.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",159.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",152.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",159.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.59,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",511.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",152.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",159.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",540.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",483.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",159.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",341.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",155.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.59,540.08,
"XR Sella Turcica",1470240,CDM,320,RC,70240,HCPCS,"OUTPATIENT ",,,196,,,131.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",176.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",55.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",186.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",166.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",117.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.47,186.2,
"XR Shoulder 1 View Left",1473021,CDM,320,RC,73020,HCPCS,"OUTPATIENT ",,,358,,,239.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",100.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",95.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",100.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.86,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",322.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",101.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",95.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",100.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",340.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",304.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",100.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",214.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",97.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.86,340.1,
"XR Shoulder 1 View Right",1473020,CDM,320,RC,73020,HCPCS,"OUTPATIENT ",,,358,,,239.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",100.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",95.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",100.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.86,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",322.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",101.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",95.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",100.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",340.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",304.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",100.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",214.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",97.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.86,340.1,
"XR Shoulder Complete 2 Views Left",1473031,CDM,320,RC,73030,HCPCS,"OUTPATIENT ",,,1037,,,694.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",290.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",277.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",290.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",933.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,952.56,167.32,1016.26,"1 through 10",other,"not separately reimbursment",293.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",277.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",290.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",985.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",881.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",290.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",622.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",283.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.11,985.15,
"XR Shoulder Complete 2 Views Right",1473030,CDM,320,RC,73030,HCPCS,"OUTPATIENT ",,,1037,,,694.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",290.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",277.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",290.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",933.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,952.56,167.32,1016.26,"1 through 10",other,"not separately reimbursment",293.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",277.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",290.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",985.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",881.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",290.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",622.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",283.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",61.11,985.15,
"XR Shunt Series",1475809,CDM,320,RC,75809,HCPCS,"OUTPATIENT ",,,544,,,364.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",152.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",145.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",152.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",201.74,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",489.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",145.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",152.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",516.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",462.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",152.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",326.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",148.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",145.63,516.8,
"XR Shuntogram Non-Vascular SI",1475809,CDM,320,RC,75809,HCPCS,"OUTPATIENT ",,,544,,,364.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",152.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",145.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",152.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",201.74,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",489.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",145.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",152.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",516.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",462.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",152.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",326.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",148.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",145.63,516.8,
"XR Sinogram",1476080,CDM,320,RC,76080,HCPCS,"OUTPATIENT ",,,499,,,334.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",139.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",133.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",139.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",449.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",141.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",133.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",139.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",474.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",424.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",139.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",299.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",136.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119,474.05,
"XR Sinuses Paranasal Complete",1470220,CDM,320,RC,70220,HCPCS,"OUTPATIENT ",,,772.85,,,517.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",216.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",206.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",216.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",76.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",695.57,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",218.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",206.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",216.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",734.21,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",656.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",216.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",463.71,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",211.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",76.84,734.21,
"XR Skull < 4 Views",1470250,CDM,320,RC,70250,HCPCS,"OUTPATIENT ",,,651.72,,,436.65,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",182.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",174.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",182.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",73.57,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",586.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",184.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",174.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",182.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",619.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",553.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",182.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",391.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",177.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",73.57,619.13,
"XR Skull Complete",1470260,CDM,320,RC,70260,HCPCS,"OUTPATIENT ",,,924.13,,,619.17,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",258.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",247.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",258.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",92.73,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",831.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",261.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",247.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",258.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",877.92,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",785.51,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",258.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",554.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",252.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",92.73,877.92,
"XR Small Bowel w/ Multiple Series",1474250,CDM,320,RC,74250,HCPCS,"OUTPATIENT ",,,868.5,,,581.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",243.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",232.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",243.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",211.91,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",781.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",245.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",232.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",243.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",825.08,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",738.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",243.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",521.1,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",237.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",211.91,825.08,
"XR Spinal Puncture Diagnostic",1462270,CDM,361,RC,62328,HCPCS,"OUTPATIENT ",,,569,,,381.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",159.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",152.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",159.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",512.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",152.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",159.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",540.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",483.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",159.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",341.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",155.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",152.32,540.55,
"XR Spine 1 View Specify Level",1472020,CDM,320,RC,72020,HCPCS,"OUTPATIENT ",,,336,,,225.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",89.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.24,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",302.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",89.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",94.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",319.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",285.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",94.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",91.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.24,319.2,
"XR Spine Cervical 2 or 3 Views",1472040,CDM,320,RC,72040,HCPCS,"OUTPATIENT ",,,265.5,,,177.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",70.3,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",238.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.34,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",225.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.34,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",70.3,252.23,
"XR Spine Cervical 4 or 5 Views",1472050,CDM,320,RC,72050,HCPCS,"OUTPATIENT ",,,1185.5,,,794.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",331.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",317.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",331.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",95.1,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1066.95,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",335.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",317.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",331.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1126.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1007.68,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",331.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",711.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",323.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",95.1,1126.23,
"XR Spine Cervical 6+ Views",1472052,CDM,320,RC,72052,HCPCS,"OUTPATIENT ",,,848.13,,,568.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",237.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",227.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",237.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",122.14,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",763.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,508.54,508.54,508.54,"1 through 10",other,"not separately reimbursment",239.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",227.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",237.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",805.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",720.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",237.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",508.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",231.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",122.14,805.72,
"XR Spine Lumbosacral 2 or 3 Views",1472100,CDM,320,RC,72100,HCPCS,"OUTPATIENT ",,,741.75,,,496.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",207.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",198.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",207.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",70.93,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",667.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,665.91,162.87,665.91,"1 through 10",other,"not separately reimbursment",209.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",198.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",207.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",704.66,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",630.49,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",207.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",445.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",202.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",70.93,704.66,
"XR Spine Lumbosacral 4+ Views",1472110,CDM,320,RC,72110,HCPCS,"OUTPATIENT ",,,1047.5,,,701.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",96.37,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",942.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",96.37,995.13,
"XR Spine Lumbosacral w/ Bending 6+ Views",1472114,CDM,320,RC,72114,HCPCS,"OUTPATIENT ",,,1081.59,,,724.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",302.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",289.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",302.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",125.69,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",973.43,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,477.21,477.21,477.21,"1 through 10",other,"not separately reimbursment",305.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",289.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",302.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1027.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",919.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",302.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",648.95,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",295.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",125.69,1027.51,
"XR Spine Scoliosis 2-3 Views",1472090,CDM,320,RC,72082,HCPCS,"OUTPATIENT ",,,350.1,,,234.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",98.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",93.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",98.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",315.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",99.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",93.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",98.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",332.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",297.59,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",98.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",210.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",95.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",93.72,332.6,
"XR Spine Thoracic 2 Views",1472070,CDM,320,RC,72070,HCPCS,"OUTPATIENT ",,,445.05,,,298.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",124.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",124.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.44,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",400.55,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,65.72,65.72,65.72,"1 through 10",other,"not separately reimbursment",125.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",124.61,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",422.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",378.29,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",124.61,28,,,,,0,"percent of total billed charges ","28% of total billed charges",267.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",121.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.44,422.8,
"XR Sternoclavicular Joint(s)",1471131,CDM,320,RC,71130,HCPCS,"OUTPATIENT ",,,405,,,271.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",113.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",108.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",113.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",73.42,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",364.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",108.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",113.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",384.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",344.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",113.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",243,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",110.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",73.42,384.75,
"XR Sternum 2+ Views",1471120,CDM,320,RC,71120,HCPCS,"OUTPATIENT ",,,194.4,,,130.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",54.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",52.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",54.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",61.84,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",174.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",52.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",54.43,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",184.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",165.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",54.43,28,,,,,0,"percent of total billed charges ","28% of total billed charges",116.64,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",53.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",52.04,184.68,
"XR Swallowing Function w/ Speech",1474230,CDM,320,RC,74230,HCPCS,"OUTPATIENT ",,,270.9,,,181.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",75.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",75.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",178.03,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",243.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,143.61,136.43,150.79,"1 through 10",other,"not separately reimbursment",76.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",72.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",75.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",257.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",230.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",75.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",162.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",73.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",72.52,257.36,
"XR Tibia/Fibula Left",1473591,CDM,320,RC,73590,HCPCS,"OUTPATIENT ",,,313.2,,,209.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",83.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",281.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,440.16,440.16,440.16,"1 through 10",other,"not separately reimbursment",88.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",83.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",87.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",297.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",266.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",187.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",85.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.64,297.54,
"XR Tibia/Fibula Right",1473590,CDM,320,RC,73590,HCPCS,"OUTPATIENT ",,,313.2,,,209.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",83.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",281.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,440.16,440.16,440.16,"1 through 10",other,"not separately reimbursment",88.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",83.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",87.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",297.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",266.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",87.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",187.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",85.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.64,297.54,
"XR TMJ Open and Closed Bilateral",1470330,CDM,320,RC,70330,HCPCS,"OUTPATIENT ",,,584.87,,,391.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",95.18,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",526.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",555.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",497.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",95.18,555.63,
"XR Toe(s) 2+ Views Left",1473661,CDM,320,RC,73660,HCPCS,"OUTPATIENT ",,,482,,,322.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.07,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",433.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",457.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",409.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.07,457.9,
"XR Toe(s) 2+ Views Right",1473660,CDM,320,RC,73660,HCPCS,"OUTPATIENT ",,,723,,,484.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",202.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",193.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",202.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.07,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",650.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",204.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",193.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",202.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",686.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",614.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",202.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",433.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",197.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.07,686.85,
"XR Upper Extremity Infant (0-1yr) Left",1473093,CDM,320,RC,73092,HCPCS,"OUTPATIENT ",,,233,,,156.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",64.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",209.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",221.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",139.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.37,221.35,
"XR Upper Extremity Infant (0-1yr) Right",1473092,CDM,320,RC,73092,HCPCS,"OUTPATIENT ",,,233,,,156.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",64.11,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",209.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",221.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",139.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.37,221.35,
"XR Upper GI",1474240,CDM,320,RC,74240,HCPCS,"OUTPATIENT ",,,1630.5,,,1092.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",436.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",223.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1467.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",461.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",436.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",456.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1548.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1385.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",978.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",445.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",223.68,1548.98,
"XR Upper GI w/ Air Contrast",1474247,CDM,320,RC,74246,HCPCS,"OUTPATIENT ",,,1349.92,,,904.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",377.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",361.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",377.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",251.64,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1214.93,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",381.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",361.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",377.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1282.42,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1147.43,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",377.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",809.95,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",368.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",251.64,1282.42,
"XR Upper GI w/ Air w/ Small Bowel",1474255,CDM,320,RC,74240,HCPCS,"OUTPATIENT ",,,1630.5,,,1092.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",436.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",223.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1467.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",461.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",436.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",456.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1548.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1385.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",978.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",445.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",223.68,1548.98,
"XR Upper GI w/ Small Bowel",1474249,CDM,320,RC,74240,HCPCS,"OUTPATIENT ",,,1630.5,,,1092.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",436.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",223.68,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",1467.45,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",461.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",436.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",456.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1548.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1385.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",456.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",978.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",445.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",223.68,1548.98,
"XR Urethrocystography Retrograde",1474420,CDM,320,RC,74420,HCPCS,"OUTPATIENT ",,,1723,,,1154.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",482.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",461.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",482.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1550.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",487.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",461.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",482.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1636.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1464.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",482.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1033.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",470.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",461.25,1636.85,
"XR Voiding Urethrocystography",1474455,CDM,320,RC,74455,HCPCS,"OUTPATIENT ",,,701,,,469.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",196.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",187.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",196.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",164.47,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",630.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",198.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",187.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",196.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",665.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",595.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",196.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",420.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",191.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",164.47,665.95,
"XR Wrist 2 Views Left",1473101,CDM,320,RC,73100,HCPCS,"OUTPATIENT ",,,454.63,,,304.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",127.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",127.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",409.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",127.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",431.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",386.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",127.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",272.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",124.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.5,431.9,
"XR Wrist 2 Views Right",1473100,CDM,320,RC,73100,HCPCS,"OUTPATIENT ",,,454.63,,,304.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",127.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",127.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",63.5,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",409.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",127.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",431.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",386.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",127.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",272.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",124.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",63.5,431.9,
"XR Wrist Complete 3+ Views Left",1473111,CDM,320,RC,73110,HCPCS,"OUTPATIENT ",,,231.75,,,155.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",74.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",208.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,346.92,346.92,346.92,"1 through 10",other,"not separately reimbursment",65.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",220.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",196.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",139.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.04,220.16,
"XR Wrist Complete 3+ Views Right",1473110,CDM,320,RC,73110,HCPCS,"OUTPATIENT ",,,231.75,,,155.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",64.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",64.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",74.34,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",208.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,346.92,346.92,346.92,"1 through 10",other,"not separately reimbursment",65.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",64.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",220.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",196.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",64.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",139.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.04,220.16,
"Zinc, Plasma or Serum LC",2284630,CDM,300,RC,84630,HCPCS,"OUTPATIENT ",,,127.27,,,85.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.65,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",114.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",35.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",108.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.6,120.91,
"Zinc, Whole Blood LC",22070032,CDM,300,RC,84630,HCPCS,"OUTPATIENT ",,,127.27,,,85.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",35.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",35.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15.65,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",114.54,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2.6,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.32,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",35.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",120.91,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",14.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",108.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",35.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",76.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.61,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",2.6,120.91,
"ZNT8 Antibodies LC",22504017,CDM,300,RC,86341,HCPCS,"OUTPATIENT ",,,148.32,,,99.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24.89,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.2,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",133.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",1.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",24.89,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",41.53,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",140.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",25.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",126.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",41.53,28,,,,,0,"percent of total billed charges ","28% of total billed charges",88.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",25.39,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",1.23,140.9,
"CT Chest/Abdomen w/ Contrast",1674162,CDM,352,RC,74160,HCPCS,"OUTPATIENT ",,,4282.44,,,2869.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1146.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",537.43,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",3854.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1136.60,1136.60,1136.60,"1 through 10",other,"not separately reimbursment",1211.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1146.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1199.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4068.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3640.07,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1199.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2569.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1169.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",537.43,4068.32,
"EGD & Colonoscopy",610018,CDM,750,RC,45378,HCPCS,"OUTPATIENT ",,,6899.75,,,4622.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1931.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1847.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1931.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",6209.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,1487.43,1487.43,1487.43,"1 through 10",other,"not separately reimbursment",1951.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1847.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1931.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6554.76,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5864.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1931.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4139.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1884.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1847.06,6554.76,
"Flow Cytometry PNH LC",22502251,CDM,310,RC,88185,HCPCS,"OUTPATIENT ",,,794.31,,,532.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",714.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",1.23,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",224.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",22.67,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",222.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",754.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",23.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",675.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",476.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",23.12,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",1.23,754.59,
"Iron Level and TIBC",2283540,CDM,301,RC,83550,HCPCS,"OUTPATIENT ",,,177.5,,,118.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12.02,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",159.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",0.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,43.68,5.37,94.81,"1 through 10",other,"not separately reimbursment",50.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.99,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",49.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",168.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",11.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",150.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",49.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",106.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.66,168.63,
"Sacroiliac Joint Radiofrequency w/Fluoro",664640,CDM,360,RC,64640,HCPCS,"OUTPATIENT ",,,920.92,,,617.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",257.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",246.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",257.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",828.83,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",260.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",246.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",257.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",874.87,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",782.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",257.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",552.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",251.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",246.53,874.87,
"Flow Cytometry PNH LC",22502251,CDM,310,RC,88187,HCPCS,"OUTPATIENT ",,,794.31,,,532.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",714.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",0.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",224.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59.78,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",222.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",754.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",60.98,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",675.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",476.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",60.98,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.66,754.59,
"14mm Self Drilling Variable Screw",691400,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"4 WHITE CAST TAPE",662708,CDM,271,RC,A4590,HCPCS,"OUTPATIENT ",,,12.75,,,8.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.57,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10.84,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.65,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.41,12.11,
"4WEB 16MM ACDF PLATE",690567,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3800,,,2546,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1017.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1900,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3420,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1074.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1017.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1064,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3610,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3230,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2280,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1037.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1017.26,3610,
"4WEB 18MM ACDF PLATE 1 LEVEL",690770,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3800,,,2546,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1017.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1900,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3420,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1074.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1017.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1064,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3610,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3230,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1064,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2280,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1037.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1017.26,3610,
"4WEB 3.5 X 14MM VARIABLE SCREW SELF-DRILLING",690568,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,300,,,201,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",300,100,,,,,0,"fee schedule","100% of total billed charges",270,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",285,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",255,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.31,300,
"4WEB 3.8 X 14MM VARIABLE ANGLE SCREW SELF-DRILLING",690774,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,300,,,201,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",300,100,,,,,0,"fee schedule","100% of total billed charges",270,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",285,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",255,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.31,300,
"4WEB 7MM ACDF CAGE",690569,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3200,,,2144,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",856.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2880,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",904.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",856.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",896,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3040,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2720,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1920,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",873.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",856.64,3040,
"4WEB INTERBODY FUSION DEVICE",690778,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3200,,,2144,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",856.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2880,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",904.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",856.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",896,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3040,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2720,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1920,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",873.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",856.64,3040,
"Achilles Tendon w/ Bone Block Frozen Irradiated",691529,CDM,278,RC,C1762,HCPCS,"OUTPATIENT ",,,9080,,,6083.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2542.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2430.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2542.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4540,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8172,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2567.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2430.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2542.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8626,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7718,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2542.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5448,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2479.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2430.72,8626,
"Acu-Loc 2 VDR Proximal Plate",690753,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"Acu-Loc 2 VDR Proximal Plate Wide, Left",691598,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"Acu-Loc VDU Plate, Long, Left",691599,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"Acumed 14.0mm Acutrak Fusion Device",691122,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1976,,,1323.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",988,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1778.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",558.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",528.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",553.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1877.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1679.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1185.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",539.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",528.98,1877.2,
"ACUMED 14MM LOCKING SCREW",690865,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED 16MM CORTICAL SCREW",690864,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"Acumed 18.0mm Acutrak Fusion System",691098,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1976,,,1323.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",988,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1778.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",558.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",528.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",553.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1877.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1679.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1185.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",539.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",528.98,1877.2,
"Acumed 2.3 mm x 14 mm Locking Cortical Screw",690342,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.3 mm x 16 mm Locking Cortical Screw",690114,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.3 mm x 18 mm Locking Cortical Screw",691597,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.3 mm x 20 mm Locking Cortical Screw",690115,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.3 mm x 22 mm Locking Cortical Screw",663251,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED 2.3 mm x 24 mm Locking Cortical Peg",690545,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.3mm X 18mm Locking Screw",690371,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.3mm X 20mm Nonlocking screw",691516,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.3mm X 24mm Nonlocking screw",691100,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.3mm X 26mm Nonlocking screw",691171,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed 2.7 mm x 20 mm Locking Hexalobe Screw",690434,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"Acumed 2.7 mm x 32 mm Locking Hexalobe Screw",691260,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"Acumed 20mm Head, Anatomic Radial Head System",690954,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12052,,,8074.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3374.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3226.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3374.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6026,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10846.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3408.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3226.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3374.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11449.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10244.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3374.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7231.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3291.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3226.32,11449.4,
"Acumed 3.5 mm x 12 mm Locking Hexalobe Screw",690039,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"Acumed 3.5 mm x 12 mm Nonlocking Hexalobe Screw",690034,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"Acumed 3.5 mm x 14 mm Nonlocking Hexalobe Screw",690066,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"Acumed 3.5 mm x 18 mm Locking Hexalobe Screw",690546,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"Acumed 3.5 mm x 20 mm Nonlocking Hexalobe Screw",690950,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"Acumed 3.5 mm x 22 mm Locking Hexalobe Screw",691259,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"Acumed 3.5 mm x 24 mm Nonlocking Hexalobe Screw",690484,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"Acumed 3.5 mm x 40 mm Nonlocking Hexalobe Screw",691258,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"Acumed 3.5 mm x 45 mm Locking Hexalobe Screw",690432,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED 3.5 X 28MM LOCKING SCREW",690820,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"ACUMED 3.5 X 30MM NONLOCKING SCREW",690817,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"ACUMED 3.5 X 34MM NONLOCKING SCREW",690819,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"ACUMED 3.5 X 55MM NONLOCKING SCREW",690818,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"Acumed 3.5mm x 14mm Locking Screw",690038,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED 3-HOLE LEFT OLECRANON PLATE",690483,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5808,,,3891.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1554.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2904,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5227.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1642.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1554.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1626.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5517.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4936.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3484.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1586.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1554.8,5517.6,
"ACUMED 5-HOLE RIGHT OLECRANON PLATE",690821,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5808,,,3891.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1554.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2904,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5227.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1642.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1554.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1626.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5517.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4936.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3484.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1586.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1554.8,5517.6,
"ACUMED 6 HOLE RADIAL PLATE",690862,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4684,,,3138.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1311.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1253.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1311.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2342,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4215.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1324.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1253.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1311.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4449.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3981.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1311.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2810.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1279.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1253.91,4449.8,
"Acumed 9.0mm x 6.0mm Stem, Anatomic Radial Head System",690955,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,13444,,,9007.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3764.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3598.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3764.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6722,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12099.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3801.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3598.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3764.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12771.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11427.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3764.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8066.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3671.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3598.96,12771.8,
"ACUMED Acu-Loc 2 VDR Plate Standard, Right",690547,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"Acumed Acu-Loc? 2 VDR Extension Plate, Neutral",690043,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5284,,,3540.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1479.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1414.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1479.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2642,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4755.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1494.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1414.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1479.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5019.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4491.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1479.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3170.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1443.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1414.53,5019.8,
"Acumed Acu-Loc? 2 VDR Proximal Plate Standard Long, Left",691057,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"ACUMED ACUTRAK FUSION SYSTEM 20.00MM",690150,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2404,,,1610.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",673.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",643.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",673.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1202,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2163.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",679.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",643.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",673.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2283.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2043.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",673.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1442.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",656.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",643.55,2283.8,
"ACUMED ACUTRAK FUSION SYSTEM 22.00MM",691072,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1976,,,1323.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",988,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1778.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",558.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",528.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",553.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1877.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1679.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1185.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",539.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",528.98,1877.2,
"ACUMED ACUTRAK FUSION SYSTEM 32.0MM",690188,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1976,,,1323.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",988,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1778.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",558.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",528.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",553.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1877.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1679.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",553.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1185.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",539.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",528.98,1877.2,
"ACUMED CORTICAL SCREW 18MM",664367,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
"ACUMED DISTAL RADIUS STANDARD PLATE LEFT",690236,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"ACUMED EXSOMED INnate Implant, 3.6  x 45mm",690524,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2900,,,1943,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",776.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1450,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2610,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",820.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",776.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",812,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2755,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2465,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1740,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",791.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",776.33,2755,
"ACUMED EXSOMED INnate Implant, 4.5 x 45mm",690523,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9564,,,6407.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2677.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2560.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2677.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4782,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8607.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2704.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2560.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2677.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9085.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8129.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2677.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5738.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2611.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2560.28,9085.8,
"ACUMED INnate Implant, 4.5 x 50mm",691534,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,10284,,,6890.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2879.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2753.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2879.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5142,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9255.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2908.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2753.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2879.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9769.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8741.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2879.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6170.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2808.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2753.03,9769.8,
"ACUMED LOCKING SCREW 2.3 X 12MM",690341,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED LOCKING SCREW 2.7 X 16MM",690435,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED LOCKING SCREW 2.7 X 18MM",690487,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED LOCKING SCREW 2.7 X 22MM",690486,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED LOCKING SCREW 2.7 X 24MM",690433,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"Acumed Narrow-profile Clavicle Plate, 8-hole Large",690949,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5520,,,3698.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1545.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1477.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1545.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2760,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4968,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1561.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1477.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1545.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5244,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4692,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1545.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3312,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1507.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1477.7,5244,
"ACUMED NONLOCKING SCREW 2.3MM X 22MM",690370,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED OLECRANON PLATE",690444,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5808,,,3891.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1554.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2904,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5227.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1642.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1554.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1626.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5517.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4936.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3484.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1586.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1554.8,5517.6,
"Acumed Olecranon Plate, Extended, 5-hole, Right 90mm",691257,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5808,,,3891.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1554.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2904,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5227.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1642.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1554.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1626.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5517.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4936.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3484.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1586.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1554.8,5517.6,
"Acumed Olecranon Plate, Standard, 7-hole, Left 110mm",690956,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5808,,,3891.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1554.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2904,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5227.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1642.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1554.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1626.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5517.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4936.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1626.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3484.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1586.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1554.8,5517.6,
"ACUMED PEG LOCKING 2.3 X 10MM",690235,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED PEG LOCKING 2.3 X 12MM",690088,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED PEG LOCKING 2.3 X 14MM",690037,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED PEG LOCKING 2.3 X 16MM",690042,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED PEG LOCKING 2.3 X 18MM",690036,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED PEG LOCKING 2.3 X 20MM",690035,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED PEG LOCKING 2.3MM X 22MM",690068,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"Acumed Plate Narrow VDR Left",690033,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"Acumed Plate Narrow VDR Right",690089,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"ACUMED RIGHT LONG VDL PLATE",690343,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"Acumed Screw Extension Link",690044,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1244,,,833.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",348.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",333.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",348.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",622,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1119.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",351.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",333.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",348.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1181.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1057.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",348.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",746.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",339.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",333.02,1181.8,
"ACUMED SCREW LOCKING 3.5MM X 10MM",690090,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED SCREW LOCKING 3.5MM X 16MM",690069,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596,100,,,,,0,"fee schedule","100% of total billed charges",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,596,
"ACUMED SCREW NONLOCKING 2.3MM X 24MM",690067,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"ACUMED SCREW NONLOCKING 3.5MM X 10MM",690041,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,584,,,391.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",156.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",584,100,,,,,0,"fee schedule","100% of total billed charges",525.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",156.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",163.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",554.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",496.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",163.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",350.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",159.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",156.34,584,
Aerobika,6990156,CDM,271,RC,S8185,HCPCS,"OUTPATIENT ",,,9,,,6.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",8.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.41,8.55,
"Alcohol Level",2282055,CDM,301,RC,G0481,HCPCS,"OUTPATIENT ",,,190,,,127.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",171,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",0.66,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,94.97,58.78,205.27,"1 through 10",other,"not separately reimbursment",53.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.79,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",53.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",180.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",131.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",161.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",53.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",114,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.37,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.66,180.5,
"ALLOGRAFT CANCELLOUS GRANULES 30CC",690372,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,3000,,,2010,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2700,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",848.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",803.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",840,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2850,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2550,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",819.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",803.1,2850,
"ALLOGRAFT TRINITY ELITE SMALL",663842,CDM,278,RC,C1762,HCPCS,"OUTPATIENT ",,,2928,,,1961.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",819.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",783.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",819.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1464,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2635.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",828.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",783.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",819.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2781.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2488.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",819.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1756.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",799.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",783.83,2781.6,
"AlloSync CB DBM Paste, 1 cc",691350,CDM,278,RC,Q4199,HCPCS,"OUTPATIENT ",,,1400,,,938,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",392,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",374.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",392,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1260,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",395.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",374.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",392,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1330,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1190,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",392,28,,,,,0,"percent of total billed charges ","28% of total billed charges",840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",382.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",374.78,1330,
"AMNIOFIX PARTICULATE 40.0MG",663117,CDM,278,RC,Q4139,HCPCS,"OUTPATIENT ",,,2988,,,2001.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",836.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",799.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",836.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1494,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2689.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",845.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",799.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",836.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2838.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2539.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",836.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1792.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",816.02,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",799.89,2838.6,
"Amniotic Placental Membrane 2cm x 3cm, thin PRO3?-P",691384,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,4340,,,2907.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1215.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1161.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1215.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2170,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3906,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1227.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1161.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1215.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4123,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3689,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1215.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2604,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1185.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1161.82,4123,
"Amniotic Placental Membrane, 4x4cm, Thin PRO3?-P",691412,CDM,278,RC,Q4100,HCPCS,"OUTPATIENT ",,,6580,,,4408.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1842.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1761.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1842.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3290,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5922,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1860.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1761.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1842.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6251,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5593,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1842.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3948,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1797,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1761.47,6251,
"ANTERIOR TIBIAL TENDON",690244,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7372,,,4939.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2064.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1973.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2064.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3686,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6634.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2084.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1973.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2064.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7003.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6266.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2064.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4423.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2013.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1973.48,7003.4,
"AOS 8mm x 15cm Proximal Humeral Nail",690588,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,17300,,,11591,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4844,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4631.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4844,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4892.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4631.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4844,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",16435,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14705,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4844,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4724.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4631.21,16435,
"AOS Cancellous Screw, 5.0mm X 30mm",690582,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1736,,,1163.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",464.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",868,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1562.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",490.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",464.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",486.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1649.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1475.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1041.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",474.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",464.73,1649.2,
"AOS Cancellous Screw, 5.0mm X 40mm",690583,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1736,,,1163.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",464.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",868,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1562.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",490.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",464.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",486.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1649.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1475.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1041.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",474.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",464.73,1649.2,
"AOS Cortical Screw, 3.5mm X 27.5mm",690585,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1736,,,1163.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",464.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",868,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1562.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",490.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",464.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",486.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1649.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1475.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1041.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",474.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",464.73,1649.2,
"AOS Cortical Screw, 3.5mm X 30mm",690584,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1736,,,1163.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",464.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",868,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1562.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",490.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",464.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",486.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1649.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1475.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",486.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1041.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",474.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",464.73,1649.2,
"Artelon FLEXBAND SOLO 0.5 x 8cm",690808,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,17252,,,11558.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4830.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4618.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4830.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8626,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15526.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4878.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4618.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4830.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",16389.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14664.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4830.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10351.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4711.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4618.36,16389.4,
"Artelon Flexband Twist .12",690961,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,16392,,,10982.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4589.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4388.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4589.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8196,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",14752.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4635.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4388.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4589.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15572.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13933.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4589.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9835.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4476.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4388.14,15572.4,
"ARTHREX  ANCHOR SWIVELOCK 4.75",663198,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2688,,,1800.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",752.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",719.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",752.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1344,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2419.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",760.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",719.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",752.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2553.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2284.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",752.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1612.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",734.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",719.58,2553.6,
"ARTHREX  Collagen Coated, FiberTape, 2 mm, 7 in (Blue) each end Tapered to #2 FiberWire",690812,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,500,,,335,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",140,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",133.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",140,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,100,,,,,0,"fee schedule","100% of total billed charges",450,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",141.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",133.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",140,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",475,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",425,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",140,28,,,,,0,"percent of total billed charges ","28% of total billed charges",300,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",136.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",133.85,500,
"ARTHREX  CORTICAL SCREW 2.4 X 10MM",664106,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,736,,,493.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",197.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",736,100,,,,,0,"fee schedule","100% of total billed charges",662.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",208.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",197.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",206.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",699.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",625.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",441.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",201,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",197.03,736,
"Arthrex 2.5 Micro x 30 mm Compression FT Screw",691646,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2336,,,1565.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",625.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2102.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",625.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",654.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2219.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1401.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",637.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",625.35,2219.2,
"Arthrex 2.6 FiberTak RC (Black/Blue)",691576,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3536,,,2369.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",946.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1768,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3182.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",999.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",946.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",990.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3359.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3005.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2121.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",965.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",946.59,3359.2,
"ARTHREX 2.6 FiberTak RC Anchor, 1.7 mm FiberTape Loop (Black/Blue), 1.3 mm SutureTape",690744,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3136,,,2101.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",839.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1568,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2822.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",886.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",839.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",878.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2979.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2665.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1881.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",856.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",839.51,2979.2,
"ARTHREX 2.6 FiberTak RC Anchor, 1.7 mm FiberTape Loop (Blue), 1.3 mm SutureTape (White/Black)",690745,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1960,,,1313.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",548.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",524.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",548.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",980,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1764,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",554.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",524.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",548.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1862,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1666,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",548.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1176,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",535.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",524.69,1862,
"Arthrex 2.6 FiberTak RC SP Soft Anchor, 1.7 mm TigerTape Loop (White/Black), 1.3 mm SutureTape (Whit",690782,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3136,,,2101.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",839.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1568,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2822.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",886.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",839.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",878.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2979.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2665.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1881.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",856.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",839.51,2979.2,
"Arthrex 2.6 FiberTak SP Soft Anchor with two 1.3 mm SutureTapes (white/blue, white/black), self-punc",690206,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2636,,,1766.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",738.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",705.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",738.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2372.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",745.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",705.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",738.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2504.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2240.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",738.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1581.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",719.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",705.66,2504.2,
"Arthrex 2.7 mm x 18 mm Cortical Screw",691609,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex 2.7 mm x 20 mm Cortical Screw",691612,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex 2.7 mm x 22 mm Cortical Screw",691611,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex 2.7 mm x 24 mm Cortical Screw",691607,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex 2.7 mm x 36 mm Cortical Screw",691610,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex 2.7 mm x 50 mm Cortical Screw",691608,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex 2.7 x 18 mm VAL KreuLock Comp. Screw, Titanium",691615,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"ARTHREX 2.9 BC Loop ?N? Tack Tenodesis Implant System Includes 2.9 mm Anchor",690850,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6000,,,4020,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1606.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1696.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1606.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1680,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5700,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5100,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1638.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1606.2,5700,
"ARTHREX 24 mm Baseplate, 20? full augment, +2 lateralized, oblique",690559,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,21336,,,14295.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5974.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5711.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5974.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",19202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6033.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5711.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5974.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20269.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",18135.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5974.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5826.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5711.65,20269.2,
"ARTHREX 24MM BASEPLATE, +2 LATERALIZED STANDARD",690472,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,21336,,,14295.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5974.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5711.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5974.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",19202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6033.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5711.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5974.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20269.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",18135.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5974.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5826.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5711.65,20269.2,
"ARTHREX 3.0 x 12 mm  Cortical Screw",690703,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,836,,,560.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",223.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",836,100,,,,,0,"fee schedule","100% of total billed charges",752.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",223.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",234.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",794.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",710.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",501.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",228.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",223.8,836,
"ARTHREX 3.0 x 18 mm  Cortical Screw",690704,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,836,,,560.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",223.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",836,100,,,,,0,"fee schedule","100% of total billed charges",752.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",223.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",234.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",794.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",710.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",501.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",228.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",223.8,836,
"Arthrex 3.5 x 38mm Beveled FT Screw",691647,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5300,,,3551,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4770,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1498.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1418.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1484,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5035,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4505,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1447.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1418.81,5035,
"Arthrex 3.5mm x 14mm Locking Screw",691409,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex 3.5mm x 16mm Locking Screw",691408,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex 3.5x34mm Beveled FT Screw",691358,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5300,,,3551,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4770,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1498.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1418.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1484,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5035,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4505,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1447.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1418.81,5035,
"Arthrex 3.5x42mm Beveled FT Screw",691359,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5300,,,3551,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4770,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1498.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1418.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1484,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5035,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4505,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1447.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1418.81,5035,
"ARTHREX 3.9 BC Loop ?N? Tack Tenodesis Implant System",690738,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5336,,,3575.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1428.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4802.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1509.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1428.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1494.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5069.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4535.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1457.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1428.45,5069.2,
"Arthrex 4 x 48mm Beveled FT Screw",691648,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5300,,,3551,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4770,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1498.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1418.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1484,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5035,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4505,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1447.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1418.81,5035,
"ARTHREX 4.0 X 40MM CANNULATED LONG THREAD SCREW",663381,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1100,,,737,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",294.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",550,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",990,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",311.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",294.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",308,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1045,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",935,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges",660,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",300.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",294.47,1045,
"Arthrex 4.3 x 40 mm Headless Compression Screw, Cannulated",691560,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2500,,,1675,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",669.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2250,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",707,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",669.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",700,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2375,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2125,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1500,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",682.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",669.25,2375,
"Arthrex 4.3 x 46 mm Headless Compression Screw, Cannulated",691561,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2500,,,1675,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",669.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2250,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",707,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",669.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",700,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2375,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2125,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1500,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",682.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",669.25,2375,
"Arthrex 4.3 x 50 mm Headless Compression Screw, Cannulated",691558,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2500,,,1675,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",669.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2250,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",707,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",669.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",700,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2375,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2125,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1500,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",682.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",669.25,2375,
"Arthrex 4.3 x 55mm Headless Compression Screw",691564,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2500,,,1675,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",669.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2250,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",707,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",669.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",700,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2375,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2125,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1500,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",682.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",669.25,2375,
"ARTHREX 4.5 mm ? 20 mm Screw, nonlocking",690561,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex 4.75/5.5 mm BioComposite SpeedBridge Implant System w/Scorpion Needle",690998,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12736,,,8533.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3566.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3409.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3566.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6368,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11462.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3601.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3409.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3566.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12099.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10825.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3566.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7641.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3478.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3409.43,12099.2,
"Arthrex 4.75/5.5 mm Knotless BioComposite SpeedBridge Anchors and SCORPION- Needle",690074,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,14336,,,9605.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4014.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3837.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4014.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12902.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4054.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3837.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4014.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13619.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12185.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4014.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8601.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3915.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3837.75,13619.2,
"Arthrex 40mm ECLIPSE Cage Screw Large",691240,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,29500,,,19765,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7897.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",26550,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8342.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7897.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8260,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28025,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25075,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8056.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7897.15,28025,
"Arthrex 5.0 Large Compression FT Screw, 70 mm Length",691567,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3168,,,2122.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",848.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1584,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2851.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",895.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",848.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",887.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3009.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2692.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1900.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",865.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",848.07,3009.6,
"Arthrex 5.0 Large Compression FT Screw, 80 mm Length",691566,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3168,,,2122.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",848.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1584,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2851.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",895.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",848.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",887.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3009.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2692.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1900.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",865.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",848.07,3009.6,
"Arthrex 5.0 x 50mm Large Compression FT Screw",691682,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3168,,,2122.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",848.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1584,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2851.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",895.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",848.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",887.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3009.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2692.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1900.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",865.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",848.07,3009.6,
"Arthrex 5.0 x 55mm Large Compression FT Screw",691681,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3168,,,2122.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",848.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1584,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2851.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",895.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",848.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",887.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3009.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2692.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1900.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",865.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",848.07,3009.6,
"ARTHREX 6 HOLE  2.4MM STRAIGHT PLATE",690387,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5300,,,3551,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4770,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1498.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1418.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1484,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5035,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4505,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1484,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1447.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1418.81,5035,
"Arthrex 7.0 mm Washer",691374,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,234,,,156.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234,100,,,,,0,"fee schedule","100% of total billed charges",210.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",222.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.64,234,
"Arthrex 7.0 XL Compression FT Screw, 110 mm Length",691653,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4636,,,3106.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1241.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4172.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1311.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1241.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1298.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4404.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3940.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2781.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1266.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1241.06,4404.2,
"Arthrex 7.0 XL Compression FT Screw, 80 mm Length",691559,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4636,,,3106.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1241.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4172.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1311.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1241.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1298.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4404.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3940.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2781.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1266.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1241.06,4404.2,
"Arthrex 7.0 XL Compression FT Screw, 85 mm Length",691651,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4636,,,3106.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1241.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4172.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1311.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1241.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1298.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4404.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3940.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2781.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1266.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1241.06,4404.2,
"Arthrex 7.0 XL Compression FT Screw, 90 mm Length",691652,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4636,,,3106.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1241.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4172.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1311.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1241.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1298.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4404.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3940.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1298.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2781.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1266.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1241.06,4404.2,
"ARTHREX ACHILLES SPEEDBRIDGE",663529,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5572,,,3733.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1560.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1491.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1560.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2786,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5014.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1575.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1491.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1560.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5293.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4736.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1560.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3343.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1521.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1491.62,5293.4,
"Arthrex ACL FiberTag TightRope ABS Implant",690958,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2236,,,1498.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",626.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",598.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",626.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1118,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2012.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",632.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",598.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",626.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2124.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1900.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",626.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1341.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",610.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",598.58,2124.2,
"Arthrex ACP Max PRP System",691078,CDM,278,RC,G0460,HCPCS,"OUTPATIENT ",,,1836,,,1230.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",514.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",491.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",514.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",918,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1652.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",519.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",491.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",514.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1744.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1560.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",514.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1101.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",501.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",491.5,1744.2,
"ARTHREX Allograft GraftLink Implant System, for InternalBrace Technique",690852,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13036,,,8734.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3650.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3489.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3650.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6518,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11732.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3686.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3489.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3650.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12384.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11080.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3650.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7821.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3560.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3489.74,12384.2,
"Arthrex AlloSync DBM Gel, 1 cc",691182,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1336,,,895.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",357.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",377.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",357.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",374.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1269.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1135.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",364.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",357.65,1269.2,
"Arthrex AlloSync DBM Putty, 5 cc",691683,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,5336,,,3575.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1428.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4802.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1509.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1428.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1494.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5069.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4535.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1457.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1428.45,5069.2,
"ARTHREX ANCHOR BC CORK VENT",663837,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1916,,,1283.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",536.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",536.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",958,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1724.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",541.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",512.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",536.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1820.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1628.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",536.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1149.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",523.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",512.91,1820.2,
"ARTHREX ANCHOR BIO C CRKSCRW TRIPLE PLAY",663560,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1564,,,1047.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",437.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",418.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",437.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",782,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1407.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",442.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",418.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",437.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1485.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1329.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",437.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",938.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",427.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",418.68,1485.8,
"ARTHREX ANCHOR BIO SWIVELOCK C",663196,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2144,,,1436.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",600.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",573.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",600.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1072,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1929.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",606.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",573.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",600.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2036.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1822.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",600.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1286.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",585.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",573.95,2036.8,
"ARTHREX ANCHOR BIOCOMP SM JNT",663516,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1496,,,1002.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",418.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",400.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",418.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",748,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1346.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",423.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",400.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",418.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1421.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1271.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",418.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",897.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",408.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",400.48,1421.2,
"ARTHREX ANCHOR PUSHLOCK 4.5",663195,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2372,,,1589.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",664.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",634.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",664.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1186,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2134.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",670.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",634.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",664.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2253.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2016.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",664.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1423.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",647.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",634.98,2253.4,
"Arthrex Angel PRP Kit",691439,CDM,278,RC,G0465,HCPCS,"OUTPATIENT ",,,2168,,,1452.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",607.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",580.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",607.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1084,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1951.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",613.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",580.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",607.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2059.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1842.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",607.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1300.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",592.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",580.37,2059.6,
"ARTHREX ARTHROCELL PLUS ALLOGRAFT 2.5CC",690383,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,12668,,,8487.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3547.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3391.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3547.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6334,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11401.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3582.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3391.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3547.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12034.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10767.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3547.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7600.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3459.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3391.22,12034.6,
"Arthrex BB-Tak",691592,CDM,278,RC,c1713,HCPCS,"OUTPATIENT ",,,334,,,223.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",93.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",89.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",93.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",334,100,,,,,0,"fee schedule","100% of total billed charges",300.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",94.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",89.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",93.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",317.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",283.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",93.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",200.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",91.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",89.41,334,
"ARTHREX BIOCARTILAGE 1CC",664110,CDM,278,RC,C9399,HCPCS,"OUTPATIENT ",,,4578.56,,,3067.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1282,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1225.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1282,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2289.28,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4120.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1294.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1225.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1282,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4349.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3891.78,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1282,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2747.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1250.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1225.68,4349.63,
"ARTHREX BIOCOMPOSITE CORK SCREW",664220,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1972,,,1321.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",552.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",527.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",552.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",986,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1774.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",557.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",527.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",552.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1873.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1676.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",552.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1183.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",538.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",527.9,1873.4,
"ARTHREX BioComposite Corkscrew FT Suture Anchor, 5.5 mm x 14.7 mm w/two #2 FiberWire",690718,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2168,,,1452.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",607.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",580.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",607.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1084,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1951.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",613.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",580.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",607.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2059.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1842.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",607.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1300.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",592.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",580.37,2059.6,
"Arthrex BioComposite Corkscrew FT Suture Anchor, 5.5 mm x 14.7 mm w/two #2 TigerTail",690301,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2300,,,1541,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",644,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",615.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",644,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1150,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2070,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",650.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",615.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",644,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2185,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1955,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",644,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",628.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",615.71,2185,
"ARTHREX BioComposite Distal Biceps Implant System with Implant",663509,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7336,,,4915.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2054.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1963.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2054.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6602.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2074.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1963.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2054.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6969.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6235.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2054.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4401.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2003.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1963.85,6969.2,
"ARTHREX BioComposite Knotless Achilles SpeedBridge with JumpStart Dressing Implant System",690710,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,19300,,,12931,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5404,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5166.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5404,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",17370,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5458.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5166.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5404,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18335,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",16405,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5404,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11580,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5270.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5166.61,18335,
"Arthrex BioComposite SutureTak Suture Anchor, 3 mm x 14.5 mm w/ two #2 TigerTail",663950,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"Arthrex BioComposite SutureTak Suture Anchor, 3 mm x 14.5 mm w/two 1.3 mm SutureTape",664646,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"Arthrex BioComposite SwiveLock C Anchor, 5.5 mm x 19.1 mm",663230,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2668,,,1787.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",747.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",714.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",747.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1334,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2401.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",754.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",714.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",747.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2534.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2267.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",747.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1600.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",728.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",714.22,2534.6,
"Arthrex BioComposite SwiveLock C, Double-Loaded, 4.75 mm x 22 mm, with two TigerWire CL",663197,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2780,,,1862.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",778.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",744.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",778.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1390,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2502,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",786.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",744.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",778.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2641,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2363,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",778.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1668,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",759.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",744.21,2641,
"Arthrex BioComposite SwiveLock SP, 5.5 mm x 24.5 mm w/ 1.3 mm SutureTape & PEEK eyelet",691067,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3136,,,2101.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",839.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1568,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2822.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",886.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",839.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",878.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2979.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2665.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",878.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1881.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",856.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",839.51,2979.2,
"ARTHREX BioComposite-Tenodesis Screw with Disposable Driver Pack, 4 x 10 mm",664332,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2700,,,1809,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",722.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1350,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2430,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",763.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",722.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",756,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2565,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2295,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1620,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",737.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",722.79,2565,
"Arthrex BioSurge II System, 5.0 cc AlloSync Pure with Arthrex Angel cPRP and BMA Tray",691088,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,11668,,,7817.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3267.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3123.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3267.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10501.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3299.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3123.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3267.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11084.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9917.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3267.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7000.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3186.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3123.52,11084.6,
"Arthrex Calcium Sulfate BioBeads, 10 cc",690992,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"Arthrex Cannulated Screw, Fully Threaded, Titanium, 3.75 mm x 30 mm",691417,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1336,,,895.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",357.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",377.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",357.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",374.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1269.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1135.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",364.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",357.65,1269.2,
"Arthrex Cannulated Screw, Fully Threaded, Titanium, 3.75 mm x 32 mm",691242,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1336,,,895.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",357.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",377.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",357.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",374.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1269.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1135.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",364.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",357.65,1269.2,
"Arthrex Cannulated Screw, Fully Threaded, Titanium, 3.75 mm x 34 mm",690612,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1336,,,895.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",357.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",377.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",357.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",374.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1269.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1135.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",364.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",357.65,1269.2,
"Arthrex Cannulated Screw, Fully Threaded, Titanium, 3.75 mm x 36 mm",691577,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1336,,,895.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",357.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",377.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",357.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",374.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1269.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1135.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",364.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",357.65,1269.2,
"Arthrex Cannulated Screw, Fully Threaded, Titanium, 3.75 mm x 38 mm",691382,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1336,,,895.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",357.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",377.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",357.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",374.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1269.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1135.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",374.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",364.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",357.65,1269.2,
"ARTHREX CHONDRAL DART 1.3 X 18MM",690480,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,808,,,541.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",226.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",216.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",226.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",808,100,,,,,0,"fee schedule","100% of total billed charges",727.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",228.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",216.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",226.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",767.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",686.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",226.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",484.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",220.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",216.3,808,
"Arthrex Compression FT Screw, 2.5 Micro, 38 mm Length",691254,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2336,,,1565.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",625.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2102.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",625.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",654.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2219.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1401.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",637.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",625.35,2219.2,
"Arthrex Compression FT Screw, 2.5 Micro, 40 mm Length",663570,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2336,,,1565.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",625.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2102.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",625.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",654.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2219.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1401.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",637.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",625.35,2219.2,
"Arthrex Compression FT Screw, 3.5 Mini, 22 mm Length",691594,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2336,,,1565.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",625.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2102.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",625.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",654.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2219.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1401.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",637.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",625.35,2219.2,
"ARTHREX Compression FT Screw, 3.5 Mini, 24 mm Length",690706,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2336,,,1565.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",625.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2102.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",625.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",654.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2219.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1401.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",637.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",625.35,2219.2,
"ARTHREX Compression FT Screw, 3.5 Mini, 40 mm Length",664205,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2336,,,1565.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",625.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2102.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",625.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",654.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2219.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1401.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",637.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",625.35,2219.2,
"ARTHREX CORTICAL SCREW 2.7 X 20MM",690460,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,300,,,201,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",300,100,,,,,0,"fee schedule","100% of total billed charges",270,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",285,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",255,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.31,300,
"ARTHREX CORTICAL SCREW 3.5 X 48MM",690459,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,234,,,156.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234,100,,,,,0,"fee schedule","100% of total billed charges",210.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",222.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.64,234,
"ARTHREX CORTICAL SCREW 3.5 X 50MM",690458,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,234,,,156.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234,100,,,,,0,"fee schedule","100% of total billed charges",210.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",222.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.64,234,
"Arthrex Cortical Screw Low Profile 3.5 x 52 mm",691282,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,163.52,,,109.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",163.52,100,,,,,0,"fee schedule","100% of total billed charges",147.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",45.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",155.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",138.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.11,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.77,163.52,
"Arthrex Cortical Screw, 2.7 mm x 12 mm",691617,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex Cortical Screw, 2.7 mm x 14 mm",691616,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex Cortical Screw, 2.7 mm x 28 mm",691626,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex Cortical Screw, 2.7 mm x 30 mm",691624,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex Cortical Screw, 2.7 mm x 60 mm",691619,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex Cortical Screw, Titanium , 2.7 mm x 54 mm",691620,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"ARTHREX CPR MINI SCORPION DX AND MICRO SUTURELASSO",663438,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5115.84,,,3427.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1432.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1369.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1432.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2557.92,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4604.26,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1446.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1369.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1432.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4860.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4348.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1432.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3069.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1397.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1369.51,4860.05,
"Arthrex Disposables Kit for DX Knotless FiberTak",690149,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1377,,,922.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",368.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",688.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1239.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",389.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",368.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",385.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1308.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1170.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",385.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",826.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",376.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",368.62,1308.15,
"Arthrex Distal Biceps Implant System (Includes: Biceps Button, 7 x10 mm PEEK Tenodesis Screw, 3.2 m",664732,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5668,,,3797.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1587.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1517.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1587.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5101.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1602.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1517.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1587.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5384.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4817.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1587.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3400.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1547.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1517.32,5384.6,
"Arthrex Distal Humerus Plate, Short, Lateral, Right, Titanium",691625,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9968,,,6678.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2818.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2668.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2791.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9469.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8472.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2722.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2668.43,9469.6,
"Arthrex Distal Humerus Plate, Short, Medial, Right, Titanium",691614,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9968,,,6678.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2818.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2668.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2791.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9469.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8472.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2722.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2668.43,9469.6,
"Arthrex Distal Humerus Plate, Short, Posterolateral, Right, Titanium",691613,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9968,,,6678.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2818.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2668.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2791.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9469.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8472.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2722.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2668.43,9469.6,
"Arthrex Double-loaded, Knotless Knee FiberTak? 2.6mm Bone Anchor",691655,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3500,,,2345,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",936.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3150,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",989.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",936.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",980,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3325,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2975,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2100,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",955.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",936.95,3325,
"Arthrex DX FiberTak Suture Anchor, #2 MTS w/ NDL",690148,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3968,,,2658.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1111.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1062.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1111.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3571.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1122.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1062.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1111.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3769.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3372.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1111.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2380.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1083.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1062.23,3769.6,
"ARTHREX DX Knotless FiberTak Instability Implant Kit",690809,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,11668,,,7817.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3267.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3123.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3267.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10501.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3299.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3123.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3267.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11084.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9917.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3267.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7000.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3186.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3123.52,11084.6,
"ARTHREX DX SwiveLock SL, with Forked Eyelet, 3.5 x 8.5 mm",663955,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2836,,,1900.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",759.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2552.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",802.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",759.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",794.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2694.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2410.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1701.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",774.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",759.2,2694.2,
"ARTHREX DYNANITE PIP IMPLANT STRAIGHT 14MM",690234,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12636,,,8466.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3382.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11372.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3573.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3382.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3538.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12004.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10740.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7581.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3450.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3382.66,12004.2,
"Arthrex DynaNite PIP Implant, Bent, 12 mm with Instrumentation",691064,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12636,,,8466.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3382.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11372.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3573.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3382.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3538.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12004.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10740.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7581.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3450.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3382.66,12004.2,
"Arthrex ECLIPSE 43mm Trunnion Shoulder Implant",691574,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,30000,,,20100,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8031,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",27000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8484,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8031,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8400,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8193,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8031,28500,
"Arthrex ECLIPSE Cage Screw x-Large, shoulder implant",690830,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,29500,,,19765,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7897.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",26550,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8342.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7897.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8260,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28025,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25075,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8056.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7897.15,28025,
"ARTHREX ECLIPSE CAGE SCREW, MEDIUM, SHOULDER IMPLANT",690441,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,29500,,,19765,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7897.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",26550,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8342.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7897.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8260,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28025,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25075,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8260,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8056.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7897.15,28025,
"Arthrex ECLIPSE Humeral Head 41/18 Shoulder Implant",691437,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,13336,,,8935.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3570.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12002.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3771.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3570.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3734.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12669.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11335.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8001.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3642.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3570.05,12669.2,
"Arthrex ECLIPSE Humeral Head 47/18",690831,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,8000,,,5360,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2141.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2262.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2141.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2240,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7600,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6800,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2184.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2141.6,7600,
"Arthrex ECLIPSE Humeral Head, 43/18, Shoulder Implant",691575,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,13336,,,8935.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3570.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12002.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3771.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3570.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3734.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12669.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11335.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8001.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3642.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3570.05,12669.2,
"Arthrex ECLIPSE Humeral Head, 45/19 shoulder implant",691241,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,13336,,,8935.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3570.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12002.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3771.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3570.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3734.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12669.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11335.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8001.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3642.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3570.05,12669.2,
"ARTHREX ECLIPSE HUMERAL HEAD, 49/18, SHOULDER IMPLANT",690442,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,13336,,,8935.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3570.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12002.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3771.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3570.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3734.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12669.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11335.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8001.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3642.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3570.05,12669.2,
"Arthrex ECLIPSE Humeral Head, 51/21",691659,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,13336,,,8935.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3570.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12002.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3771.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3570.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3734.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12669.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11335.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8001.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3642.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3570.05,12669.2,
"Arthrex ECLIPSE Humeral Head, 55/21",691419,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,13336,,,8935.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3570.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12002.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3771.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3570.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3734.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12669.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11335.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3734.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8001.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3642.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3570.05,12669.2,
"ARTHREX ECLIPSE SPEEDSCAP IMPLANT SYSTEM, BONE ANCHOR",690437,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,16668,,,11167.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4667.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4462.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4667.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8334,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15001.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4713.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4462.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4667.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15834.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14167.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4667.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10000.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4552.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4462.02,15834.6,
"ARTHREX ECLIPSE TRUNION 47 SHOULDER IMPLANT",690608,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,18000,,,12060,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4818.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5090.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4818.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5040,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17100,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15300,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4915.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4818.6,17100,
"ARTHREX ECLIPSE TRUNION 49 SHOULDER IMPLANT",690440,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,18000,,,12060,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4818.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5090.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4818.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5040,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17100,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15300,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4915.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4818.6,17100,
"Arthrex ECLIPSE Trunnion 51 mm Shoulder Implant",691658,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,30000,,,20100,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8031,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",27000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8484,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8031,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8400,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8193,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8031,28500,
"Arthrex ECLIPSE Trunnion, 41mm Shoulder Implant",691436,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,30000,,,20100,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8031,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",27000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8484,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8031,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8400,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8193,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8031,28500,
"Arthrex ECLIPSE Trunnion, 45mm, Shoulder Implant/ Slotted, TPS and CaP Coated",691239,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,30000,,,20100,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8031,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",27000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8484,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8031,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8400,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8193,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8031,28500,
"Arthrex ECLIPSE Trunnion, Slotted, TPS and CaP Coated, 55 mm",691418,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,30000,,,20100,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8031,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",27000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8484,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8031,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8400,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8400,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8193,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8031,28500,
"ARTHREX ENDO PLANTAR FASCIA RELEASE SYSTEM",690289,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5968,,,3998.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1671.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1597.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1671.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5371.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1687.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1597.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1671.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5669.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5072.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1671.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3580.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1629.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1597.63,5669.6,
"Arthrex FastThread BioComposite Interference Screw, 6 x 20 mm",691677,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2636,,,1766.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",738.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",705.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",738.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2372.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",745.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",705.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",738.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2504.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2240.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",738.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1581.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",719.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",705.66,2504.2,
"Arthrex FastThread BioComposite Interference Screw, 7 x 20 mm",691272,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"ARTHREX FastThread PEEK Interference Screw 10 mm ? 20 mm screw",690836,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"ARTHREX FastThread PEEK Interference Screw 11 mm ? 30 mm screw",690837,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex FiberStitch Implant 1.5, 24? Curve with two Polyester Implants and 2-0 FiberWire Suture",690785,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3668,,,2457.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1027.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",981.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1027.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3301.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1037.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",981.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1027.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3484.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3117.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1027.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2200.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1001.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",981.92,3484.6,
"Arthrex FiberStitch Implant 1.5, Curved with two Polyester Implants and 2-0 FiberWire Suture",691099,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3668,,,2457.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1027.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",981.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1027.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3301.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1037.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",981.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1027.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3484.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3117.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1027.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2200.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1001.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",981.92,3484.6,
"ARTHREX FiberStitch Implant, 24? Curve with two Polyester Implants and 2-0 FiberWire Suture",690519,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3300,,,2211,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",883.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2970,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",933.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",883.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",924,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3135,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2805,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1980,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",901.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",883.41,3135,
"ARTHREX FIBERSTITCH IMPLANT, CURVED W/ 2 POLY IMPLANTS & 2-0 FIBERWIRE SUTURE, ANATOMICAL LIGATURE",690327,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3300,,,2211,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",883.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2970,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",933.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",883.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",924,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3135,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2805,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1980,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",901.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",883.41,3135,
"Arthrex FiberTag TightRope II ABS Implant",691212,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2700,,,1809,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",722.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1350,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2430,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",763.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",722.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",756,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2565,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2295,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1620,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",737.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",722.79,2565,
"ARTHREX FiberTag TightRope II implant with FiberTape Suture",690890,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4836,,,3240.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1294.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4352.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1367.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1294.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1354.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4594.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4110.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2901.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1320.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1294.6,4594.2,
"Arthrex FiberTag TightRope Soft Button",691531,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4568,,,3060.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1279.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1222.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1279.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2284,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4111.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1291.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1222.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1279.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4339.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3882.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1279.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2740.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1247.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1222.85,4339.6,
"Arthrex FiberTag TightRope Soft Button, for the InternalBrace Technique",691530,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5236,,,3508.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1466.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1401.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1466.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2618,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4712.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1480.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1401.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1466.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4974.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4450.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1466.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3141.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1429.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1401.68,4974.2,
"Arthrex FiberTak Biceps Implant System w/ FiberTak Biceps Anchor, Slotted Drill Guide and 1.9 mm Dri",690073,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4168,,,2792.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1167.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1115.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1167.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2084,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3751.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1178.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1115.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1167.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3959.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3542.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1167.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2500.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1138.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1115.77,3959.6,
"ARTHREX FiberTak DX Suture Anchor, Double-Loaded",664352,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3500,,,2345,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",936.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3150,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",989.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",936.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",980,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3325,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2975,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2100,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",955.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",936.95,3325,
"ARTHREX FiberTak SpeedBridge Implant System 4.75mm",690851,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,17300,,,11591,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4844,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4631.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4844,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4892.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4631.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4844,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",16435,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14705,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4844,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4724.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4631.21,16435,
"Arthrex FiberTape Cerclage (Blue) w/ TigerLink Suture Shuttle and Loader",691261,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3168,,,2122.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",848.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1584,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2851.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",895.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",848.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",887.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3009.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2692.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",887.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1900.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",865.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",848.07,3009.6,
"ARTHREX FIBERTAPE COMPRESSION BRIDGE",690609,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4000,,,2680,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1070.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3600,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1131.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1070.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1120,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3800,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3400,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2400,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1092.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1070.8,3800,
"Arthrex FiberTape Sternal Closure Kit x 4, 2mm x 36",691569,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6500,,,4355,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1740.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5850,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1838.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1740.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1820,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6175,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5525,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3900,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1775.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1740.05,6175,
"ARTHREX FIBULOCK NAIL 3.0 X 130MM, RIGHT",690548,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,19968,,,13378.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5591.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5345.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5591.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",17971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5646.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5345.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5591.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18969.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",16972.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5591.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5453.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5345.43,18969.6,
"ARTHREX FIBULOCK NAIL 3.8 X 130MM, RIGHT",690451,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,19968,,,13378.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5591.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5345.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5591.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",17971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5646.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5345.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5591.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18969.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",16972.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5591.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5453.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5345.43,18969.6,
"Arthrex FibuLock Nail, 3.0 x 130 mm Left",691284,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13992.64,,,9375.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3917.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3745.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3917.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6996.32,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12593.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3957.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3745.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3917.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13293.01,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11893.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3917.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8395.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3821.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3745.83,13293.01,
"ARTHREX GraftLink L = 60 - 80 mm; D = 7.5 - 10.5 mm",663648,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,19372,,,12979.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5424.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5185.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5424.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9686,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",17434.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5478.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5185.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5424.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18403.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",16466.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5424.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11623.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5290.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5185.88,18403.4,
"Arthrex Guidewire with Trocar Tip, 1.35 mm",691132,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,75,,,50.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",20.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",75,100,,,,,0,"fee schedule","100% of total billed charges",67.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",20.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",71.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",63.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",45,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",20.08,75,
"ARTHREX Humeral Insert, L/42/+3",690556,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6768,,,4534.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1811.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3384,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6091.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1913.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1811.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1895.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6429.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5752.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4060.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1848.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1811.79,6429.6,
"ARTHREX Hybrid Knee FiberTak Anchor (Knotless and Knotted), Self-Punching",690896,CDM,278,RC,C1773,HCPCS,"OUTPATIENT ",,,3500,,,2345,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",936.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3150,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",989.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",936.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",980,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3325,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2975,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2100,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",955.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",936.95,3325,
"ARTHREX iBalance UKA Femoral, Cemented Size 3, Right Medial/ Left Lateral",690874,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"ARTHREX iBalance UKA Tibial Bearing Implant, VIT E Size 3 (8mm Thickness)",690875,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6000,,,4020,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1606.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1696.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1606.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1680,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5700,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5100,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1638.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1606.2,5700,
"ARTHREX iBalance UKA Tibial Cemented Tray, Size 3",690873,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12000,,,8040,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3212.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3393.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3212.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3360,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11400,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10200,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3277.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3212.4,11400,
"ARTHREX IMPLANT SYSTEM MENISCAL ROOT REPAIR WITH PEEK SWIVELOCK",690340,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9300,,,6231,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2604,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2489.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2604,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8370,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2630.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2489.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2604,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8835,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7905,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2604,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5580,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2539.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2489.61,8835,
"ARTHREX IMPLANT SYSTEM SECONDARY FIXATION WITH BIOCOMPOSITE SWIVELOCK",690336,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4836,,,3240.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1294.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4352.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1367.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1294.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1354.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4594.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4110.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2901.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1320.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1294.6,4594.2,
"Arthrex Implant System, APRS Achilles Midsubstance SpeedBridge with JumpStart Dressing",691019,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,18336,,,12285.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5134.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4908.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5134.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16502.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5185.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4908.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5134.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17419.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15585.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5134.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11001.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5007.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4908.55,17419.2,
"Arthrex Implant System, BioComposite Achilles SpeedBridge with JumpStart",663542,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13300,,,8911,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3560.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11970,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3761.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3560.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3724,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12635,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11305,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7980,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3632.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3560.41,12635,
"Arthrex Implant System, CMC Mini TightRope, 1.1 mm",664056,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5968,,,3998.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1671.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1597.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1671.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5371.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1687.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1597.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1671.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5669.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5072.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1671.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3580.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1629.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1597.63,5669.6,
"Arthrex Implant System, DX Knotless SwiveLock, BioComposite,4.75 mm",690869,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6636,,,4446.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1858.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1776.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1858.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5972.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1876.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1776.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1858.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6304.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5640.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1858.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3981.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1812.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1776.46,6304.2,
"Arthrex Implant System, Hand/Wrist InternalBrace",664156,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9968,,,6678.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2818.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2668.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2791.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9469.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8472.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2722.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2668.43,9469.6,
"ARTHREX Implant System, InternalBrace Knee Ligament Augmentation Repair with anchors and instruments",690895,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7968,,,5338.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2231.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2133.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2231.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7171.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2253.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2133.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2231.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7569.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6772.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2231.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4780.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2176.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2133.03,7569.6,
"Arthrex Implant System, Meniscal Root Repair with BioComposite SwiveLock",691508,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,11336,,,7595.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3174.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3034.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3174.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10202.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3205.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3034.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3174.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10769.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9635.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3174.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3095.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3034.65,10769.2,
"ARTHREX Implant System, Secondary Fixation with PEEK SwiveLock Anchor 4.75 x 19.1 mm",690838,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4836,,,3240.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1294.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4352.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1367.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1294.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1354.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4594.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4110.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1354.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2901.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1320.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1294.6,4594.2,
"ARTHREX INTERNAL BRACE LIGAMENT REPAIR",663157,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6144,,,4116.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1720.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1644.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1720.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3072,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5529.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1737.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1644.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1720.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5836.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5222.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1720.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3686.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1677.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1644.75,5836.8,
"Arthrex InternalBrace Implant System, Ligament Augmentation Repair, BioComposite, with Collagen Coat",664353,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9968,,,6678.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2818.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2668.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2791.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9469.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8472.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2722.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2668.43,9469.6,
"Arthrex Knee FiberTak Button 2.6mm",691662,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3300,,,2211,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",883.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2970,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",933.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",883.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",924,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3135,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2805,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",924,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1980,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",901.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",883.41,3135,
"Arthrex Knee FiberTak Double Knotted",691427,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2836,,,1900.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",759.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2552.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",802.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",759.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",794.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2694.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2410.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1701.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",774.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",759.2,2694.2,
"ARTHREX Knotless 1.8 FiberTak Soft Anchor, w/ #2 Suture",690844,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2936,,,1967.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",822.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",785.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",822.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1468,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2642.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",830.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",785.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",822.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2789.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2495.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",822.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1761.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",801.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",785.97,2789.2,
"ARTHREX Knotless 1.8 FiberTak w/ #2 Suture",690843,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2800,,,1876,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",784,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",749.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",784,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2520,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",791.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",749.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",784,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2660,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2380,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",784,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1680,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",764.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",749.56,2660,
"Arthrex Knotless 1.8 FiberTak? Soft Anchor",691420,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,11000,,,7370,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2944.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3110.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2944.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3080,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10450,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9350,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3004.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2944.7,10450,
"Arthrex Knotless 2.6 FiberTak RC SP Soft Anchor, Self-Punching,",690076,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3536,,,2369.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",946.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1768,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3182.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",999.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",946.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",990.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3359.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3005.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2121.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",965.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",946.59,3359.2,
"ARTHREX Knotless BioComposite SutureTak Anchor, 3 mm x 12.7 mm, with #2 FiberWire CL Suture",663627,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2836,,,1900.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",759.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2552.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",802.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",759.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",794.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2694.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2410.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1701.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",774.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",759.2,2694.2,
"Arthrex Knotless BioComposite SwiveLock Anchor, 4.75 mm x 19.1 mm with #2 Suture (Blue)",690783,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3068,,,2055.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",859.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",821.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",859.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1534,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2761.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",867.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",821.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",859.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2914.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2607.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",859.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1840.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",837.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",821.3,2914.6,
"Arthrex Knotless BioComposite SwiveLock Anchor, 5.5 mm x 19.1 mm w/ #2 Suture",690052,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3068,,,2055.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",859.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",821.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",859.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1534,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2761.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",867.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",821.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",859.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2914.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2607.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",859.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1840.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",837.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",821.3,2914.6,
"ARTHREX KNOTLESS FIBERTAK RC WHITE/BLACK",690075,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3536,,,2369.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",946.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1768,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3182.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",999.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",946.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",990.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3359.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3005.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",990.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2121.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",965.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",946.59,3359.2,
"Arthrex Knotless Tensionable FiberTak Biceps Implant System",691074,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6600,,,4422,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1766.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5940,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1866.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1766.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1848,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6270,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5610,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3960,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1802.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1766.82,6270,
"Arthrex KreuLock Compression Screw, 3.5 x 20 mm, Titanium",691131,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex KreuLock Compression Screw, 3.5 x 22 mm, Titanium",691133,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex KreuLock Compression Screws, Ti, 3.5 mm x 16mm",691165,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"ARTHREX KREWBACK SCREW 2.4 X 10MM",690385,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex Lisfranc Plate, Small, Right, Titanium",664321,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5336,,,3575.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1428.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4802.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1509.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1428.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1494.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5069.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4535.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1494.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1457.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1428.45,5069.2,
"Arthrex Locking Distal Fibula Plate, Left, 5 Hole",691406,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4668,,,3127.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1307.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1249.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1307.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2334,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4201.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1320.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1249.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1307.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4434.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3967.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1307.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2800.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1274.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1249.62,4434.6,
"Arthrex Locking Distal Fibula Plate, Left, 6 Hole",691129,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5168,,,3462.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1447.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1383.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1447.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2584,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4651.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1461.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1383.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1447.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4909.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4392.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1447.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3100.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1411.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1383.47,4909.6,
"ARTHREX Locking Distal Fibula Plate, SS, Left, 8 Hole",663377,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5836,,,3910.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1634.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1562.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1634.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2918,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5252.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1650.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1562.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1634.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5544.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4960.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1634.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3501.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1593.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1562.3,5544.2,
"ARTHREX Low Pro?le Nonlocking Screw, SS, 3.5 x 16 mm, Cortical",663379,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,234,,,156.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234,100,,,,,0,"fee schedule","100% of total billed charges",210.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",222.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.64,234,
"Arthrex Low Profile Locking Screw, 3.5 mm x 14 mm, Titanium",691124,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"ARTHREX Low Profile Locking Screw, SS, 2.7 x 12 mm",690649,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,768,,,514.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",768,100,,,,,0,"fee schedule","100% of total billed charges",691.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",729.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",652.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",460.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",209.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.59,768,
"ARTHREX Low Profile Locking Screw, SS, 2.7 x 14 mm",663378,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,768,,,514.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",768,100,,,,,0,"fee schedule","100% of total billed charges",691.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",729.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",652.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",460.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",209.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.59,768,
"ARTHREX Low Profile Locking Screw, SS, 3.5 x 16 mm",663380,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,768,,,514.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",768,100,,,,,0,"fee schedule","100% of total billed charges",691.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",729.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",652.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",460.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",209.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.59,768,
"Arthrex Low Profile Nonlocking Screw, SS, 3 x 14 mm, Cancellous",691286,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,163.52,,,109.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",163.52,100,,,,,0,"fee schedule","100% of total billed charges",147.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",45.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",155.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",138.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.11,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.77,163.52,
"Arthrex Low Profile Nonlocking Screw, SS, 3 x 16 mm, Cancellous",691281,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,163.52,,,109.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",163.52,100,,,,,0,"fee schedule","100% of total billed charges",147.17,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",46.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",45.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",155.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",138.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",45.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",98.11,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",44.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.77,163.52,
"Arthrex Low Profile Screw, 3.5 x 14 mm, Titanium",691160,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,400,,,268,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",400,100,,,,,0,"fee schedule","100% of total billed charges",360,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.08,400,
"Arthrex Low Profile Screw, 3.5 x 16 mm, Titanium",691123,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,400,,,268,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",400,100,,,,,0,"fee schedule","100% of total billed charges",360,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.08,400,
"Arthrex Low Profile Screw, 3.5 x 20 mm, Titanium",691126,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,400,,,268,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",400,100,,,,,0,"fee schedule","100% of total billed charges",360,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.08,400,
"Arthrex Low Profile Screw, 3.5 x 24 mm, Titanium",691134,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,400,,,268,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",400,100,,,,,0,"fee schedule","100% of total billed charges",360,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.08,400,
"Arthrex Low Profile Screw, 3.5 x 34 mm, Titanium",691125,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,400,,,268,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",400,100,,,,,0,"fee schedule","100% of total billed charges",360,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.08,400,
"Arthrex Low Profile Screw, 3.5 x 42 mm, Titanium",691161,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,400,,,268,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",400,100,,,,,0,"fee schedule","100% of total billed charges",360,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.08,400,
"Arthrex Low Profile Screw, Cortical, 3 x 12 mm, Titanium",691163,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,736,,,493.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",197.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",736,100,,,,,0,"fee schedule","100% of total billed charges",662.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",208.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",197.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",206.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",699.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",625.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",441.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",201,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",197.03,736,
"Arthrex Low Profile Screw, Cortical, 3 x 14 mm, Titanium",691164,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,736,,,493.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",197.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",736,100,,,,,0,"fee schedule","100% of total billed charges",662.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",208.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",197.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",206.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",699.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",625.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",441.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",201,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",197.03,736,
"Arthrex Low Profile Screw, Cortical, 3 x 18 mm, Titanium",691162,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,736,,,493.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",197.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",736,100,,,,,0,"fee schedule","100% of total billed charges",662.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",208.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",197.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",206.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",699.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",625.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",441.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",201,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",197.03,736,
"Arthrex Low Profile Screw, Cortical, 3 x 20 mm, Titanium",691407,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,736,,,493.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",197.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",736,100,,,,,0,"fee schedule","100% of total billed charges",662.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",208.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",197.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",206.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",699.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",625.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",206.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",441.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",201,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",197.03,736,
"Arthrex Low Profile Screw, SS, 3.5 x 35 mm, Cortical",690773,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,234,,,156.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234,100,,,,,0,"fee schedule","100% of total billed charges",210.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",222.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.64,234,
"Arthrex Low Profile Screw, SS, 4.0 x 40 mm, Cannulated, Long Thread",691285,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,770.88,,,516.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",206.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",770.88,100,,,,,0,"fee schedule","100% of total billed charges",693.79,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",218,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",206.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",732.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",655.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",462.53,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",210.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",206.36,770.88,
"ARTHREX Low Profile Screw, SS, 4.0 x 45 mm, Cannulated, Long Thread",690550,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1100,,,737,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",294.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",550,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",990,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",311.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",294.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",308,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1045,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",935,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges",660,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",300.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",294.47,1045,
"ARTHREX Low Profle Nonlocking Screw, SS, 2.7 x 18 mm, Cortical",690462,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,300,,,201,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",80.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",300,100,,,,,0,"fee schedule","100% of total billed charges",270,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",80.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",285,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",255,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",180,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",81.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",80.31,300,
"ARTHREX Low Profle Nonlocking Screw, SS, 3.5 x 20 mm, Cortical",690648,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,234,,,156.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",62.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",234,100,,,,,0,"fee schedule","100% of total billed charges",210.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",62.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",65.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",222.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",198.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",65.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",140.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",63.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",62.64,234,
"Arthrex MaxForce MTP Compression Plate, 0? petite, left",691593,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13300,,,8911,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3560.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11970,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3761.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3560.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3724,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12635,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11305,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7980,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3632.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3560.41,12635,
"ARTHREX MaxForce MTP Compression Plate, Std, 5? Valgus, 5? Dorsiflex, Right",690709,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13300,,,8911,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3560.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11970,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3761.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3560.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3724,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12635,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11305,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7980,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3632.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3560.41,12635,
"ARTHREX MIS BioComposite Knotless FiberTak? Achilles",690675,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,21300,,,14271,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5964,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5702.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5964,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",19170,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6023.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5702.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5964,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20235,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",18105,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5964,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12780,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5817.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5702.01,20235,
"ARTHREX MODULAR POST FOR AUGMENTED MGS BASEPLATE, 25MM",690560,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9668,,,6477.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2707.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2588.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2707.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8701.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2734.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2588.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2707.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9184.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8217.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2707.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5800.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2640.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2588.12,9184.6,
"ARTHREX MODULAR POST FOR AUGMENTED MGS BASEPLATE, 30MM",690471,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9668,,,6477.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2707.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2588.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2707.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8701.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2734.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2588.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2707.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9184.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8217.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2707.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5800.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2640.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2588.12,9184.6,
"ARTHREX MPFL ACL TIGHTROPE IMPLANT",663960,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9640,,,6458.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2699.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2580.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2699.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4820,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8676,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2726.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2580.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2699.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9158,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8194,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2699.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5784,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2632.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2580.63,9158,
"ARTHREX MPFL Implant System, FastThread Screw and BioComposite SwiveLock Anchors, 3.9 x 17.9 mm/6 x",690540,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13300,,,8911,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3560.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11970,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3761.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3560.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3724,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12635,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11305,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7980,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3632.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3560.41,12635,
"ARTHREX MPFL TIGHTROPE BIOCOMPOSITE SWIVELOCK IMPLANT SYSTEM",690071,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13300,,,8911,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3560.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11970,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3761.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3560.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3724,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12635,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11305,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3724,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7980,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3632.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3560.41,12635,
"Arthrex Nano SwiveLock Suture Anchor with Fork Eyelet, 2.5 x 7 mm",691093,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3500,,,2345,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",936.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3150,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",989.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",936.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",980,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3325,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2975,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",980,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2100,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",955.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",936.95,3325,
"Arthrex Olecranon Osteotomy Plate, Right, Titanium",691618,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8636,,,5786.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2418.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2311.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2418.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7772.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2442.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2311.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2418.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8204.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7340.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2418.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5181.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2358.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2311.86,8204.2,
"Arthrex Pec Repair Large Eyelets",691520,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,11000,,,7370,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2944.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3110.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2944.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3080,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10450,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9350,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3004.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2944.7,10450,
"ARTHREX PEEK INTERFERENCE SCREW 9 X 23MM",690322,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1668,,,1117.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",467.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",446.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",467.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1501.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",471.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",446.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",467.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1584.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1417.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",467.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1000.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",455.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",446.52,1584.6,
"ARTHREX PEEK SwiveLock Anchor, 3.9 mm x 17.9 mm",690822,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,2500,,,1675,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",669.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2250,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",707,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",669.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",700,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2375,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2125,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1500,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",682.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",669.25,2375,
"ARTHREX PLATE 2.4 LP STRAIGHT",664105,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3972,,,2661.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1112.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1063.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1112.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1986,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3574.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1123.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1063.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1112.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3773.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3376.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1112.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2383.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1084.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1063.3,3773.4,
"ARTHREX PROXIMAL TENODESIS IMPLANT SYSTEM",690389,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4500,,,3015,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1260,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1204.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1260,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4050,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1272.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1204.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1260,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4275,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3825,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1260,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1228.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1204.65,4275,
"ARTHREX QuadLink Implant System, 9 mm",691213,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,14500,,,9715,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4060,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3881.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4060,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13050,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4100.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3881.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4060,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13775,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12325,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4060,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3959.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3881.65,13775,
"Arthrex Quadlink Implant System, with TightRope implants 9 mm QuadPro",691354,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,19036,,,12754.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5330.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5095.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5330.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9518,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",17132.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5383.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5095.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5330.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18084.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",16180.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5330.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11421.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5198.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5095.94,18084.2,
"ARTHREX QuadLink Implant System,10 mm",690888,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,14500,,,9715,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4060,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3881.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4060,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13050,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4100.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3881.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4060,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13775,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12325,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4060,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3959.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3881.65,13775,
"Arthrex QuickFix Screw 4.0 x 36 mm Cannulated, Short Thread",691375,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1100,,,737,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",294.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",550,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",990,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",311.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",294.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",308,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1045,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",935,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges",660,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",300.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",294.47,1045,
"Arthrex QuickFix Screw 4.0 x 46 mm, Cannulated, Short Thread",691373,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1100,,,737,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",294.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",550,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",990,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",311.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",294.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",308,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1045,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",935,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges",660,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",300.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",294.47,1045,
"ARTHREX SCREW 2.4 LOCK",664107,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,716,,,479.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",200.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",191.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",200.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",716,100,,,,,0,"fee schedule","100% of total billed charges",644.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",202.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",191.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",200.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",680.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",608.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",200.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",429.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",195.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",191.67,716,
"ARTHREX SCREW 2.4 VA LOCK",664108,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"ARTHREX SCREW BIOCOMPOSITE",663335,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1344,,,900.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",376.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",359.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",376.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",672,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1209.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",380.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",359.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",376.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1276.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1142.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",376.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",806.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",367.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",359.79,1276.8,
"ARTHREX SCREW CANN IF W/SHEATH",663657,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,460,,,308.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",460,100,,,,,0,"fee schedule","100% of total billed charges",414,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.14,460,
"ARTHREX SCREW CANN INTERF FL THRD 20MM",663656,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,380,,,254.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",101.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",380,100,,,,,0,"fee schedule","100% of total billed charges",342,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",107.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",101.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",361,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",323,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",228,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",103.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",101.73,380,
"ARTHREX SCREW CANNULATED INTERFERENCE FULL THREAD 7MM X 20MM",690093,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,636,,,426.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",636,100,,,,,0,"fee schedule","100% of total billed charges",572.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",179.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",170.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",178.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",604.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",540.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",381.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",173.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",170.26,636,
"ARTHREX SCREW CANNULATED INTERFERENCE WITH DISPOSABLE SHEATH 7MM X 20MM",690092,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,768,,,514.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",768,100,,,,,0,"fee schedule","100% of total billed charges",691.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",729.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",652.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",460.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",209.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.59,768,
"ARTHREX SCREW TENO BIO-COMP",663592,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1768,,,1184.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",495.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",473.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",495.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",884,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1591.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",499.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",473.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",495.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1679.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1502.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",495.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1060.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",482.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",473.29,1679.6,
"ARTHREX SCREW TENODESIS PEEK",663591,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1680,,,1125.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",449.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",840,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1512,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",475.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",449.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",470.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1596,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1428,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1008,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",458.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",449.74,1596,
"ARTHREX SELF-PUNCHING KNOTLESS 2.6 FIBERTAK ANCHOR WITH #5 SUTURE",690450,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2102.4,,,1408.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",588.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",562.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",588.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1051.2,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1892.16,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",594.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",562.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",588.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1997.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1787.04,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",588.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1261.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",574.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",562.81,1997.28,
"ARTHREX SNAP OFF SCREW 10MM",690299,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2336,,,1565.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",625.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2102.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",625.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",654.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2219.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",654.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1401.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",637.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",625.35,2219.2,
"ARTHREX SUTURE ANCHOR 2.4 X 8.5",663158,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1860,,,1246.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",520.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",497.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",520.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",930,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1674,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",526.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",497.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",520.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1767,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1581,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",520.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1116,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",507.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",497.92,1767,
"ARTHREX SUTURE ANCHOR, BIOCOMPOSITE SUTURE TAK",690590,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2836,,,1900.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",759.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2552.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",802.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",759.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",794.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2694.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2410.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",794.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1701.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",774.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",759.2,2694.2,
"Arthrex Suture Anchor, Micro Corkscrew FT 2.2 mm x 4mm",664672,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1331.52,,,892.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",372.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",356.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",372.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",665.76,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1198.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",376.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",356.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",372.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1264.94,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1131.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",372.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",798.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",363.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",356.45,1264.94,
"Arthrex Suture Anchor, SwiveLock Tenodesis, BioComposite, 6.25 x 19.1 mm",663219,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2736,,,1833.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",766.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",732.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",766.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1368,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2462.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",773.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",732.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",766.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2599.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2325.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",766.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1641.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",747.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",732.43,2599.2,
"Arthrex Suture Anchor, SwiveLock Tenodesis, BioComposite, 7 mm x 19.1 mm",690425,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2900,,,1943,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",776.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1450,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2610,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",820.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",776.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",812,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2755,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2465,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1740,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",791.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",776.33,2755,
"Arthrex Suture Button, 12 mm",691192,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,668,,,447.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",187.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",178.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",187.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",668,100,,,,,0,"fee schedule","100% of total billed charges",601.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",178.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",187.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",634.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",567.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",187.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",400.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",182.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",178.82,668,
"Arthrex Suture Washer, Titanium, with #2 FiberWire and Curved Needle",690611,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,836,,,560.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",223.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",836,100,,,,,0,"fee schedule","100% of total billed charges",752.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",223.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",234.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",794.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",710.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",501.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",228.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",223.8,836,
"ARTHREX SwiveLock Implant System (Includes: one 4.75 mm BioComposite SwiveLock C Preloaded with Blue",663851,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4268,,,2859.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1195.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1142.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1195.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2134,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3841.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1206.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1142.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1195.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4054.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3627.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1195.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2560.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1165.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1142.54,4054.6,
"Arthrex Syndesmosis TightRope PRO Implant",691654,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12636,,,8466.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3382.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11372.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3573.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3382.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3538.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12004.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10740.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3538.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7581.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3450.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3382.66,12004.2,
"Arthrex Syndesmosis TightRope XP Buttress Plate Implant System, Syndesmosis 2 Hole Buttress Plate, 1",690901,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,26636,,,17846.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7458.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7130.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7458.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",23972.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7532.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7130.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7458.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25304.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22640.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7458.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15981.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7274.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7130.46,25304.2,
"Arthrex Syndesmosis TightRope XP, Stainless Steel",690772,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6984.64,,,4679.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1955.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1869.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1955.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3492.32,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6286.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1975.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1869.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1955.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6635.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5936.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1955.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4190.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1907.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1869.79,6635.41,
"Arthrex Syndesmosis TightRope XP, Titanium",690288,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9968,,,6678.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2668.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8971.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2818.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2668.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2791.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9469.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8472.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2791.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5980.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2722.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2668.43,9469.6,
"ARTHREX Tenodesis Screw, PEEK, Vented, 3 x 8 mm",690680,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2700,,,1809,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",722.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1350,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2430,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",763.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",722.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",756,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2565,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2295,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",756,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1620,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",737.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",722.79,2565,
"ARTHREX TightRope ABS Button, Round, Concave 11 mm",690889,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1147.5,,,768.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",321.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",307.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",321.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",573.75,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1032.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",324.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",307.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",321.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1090.13,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",975.38,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",321.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",688.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",313.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",307.19,1090.13,
"ARTHREX UNIVERS REVERS HUMERAL INSERT MEDIUM 39/ +6 CONSTRAINED",690477,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6768,,,4534.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1811.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3384,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6091.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1913.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1811.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1895.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6429.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5752.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4060.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1848.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1811.79,6429.6,
"ARTHREX UNIVERS REVERS HUMERAL STEM, SIZE 10, SHOULDER IMPLANT",690474,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,16568,,,11100.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4639.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4435.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4639.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8284,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",14911.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4685.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4435.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4639.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15739.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14082.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4639.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9940.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4524.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4435.25,15739.6,
"ARTHREX UNIVERS REVERS HUMERAL STEM, SIZE 11, SHOULDER IMPLANT",690565,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,16568,,,11100.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4639.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4435.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4639.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8284,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",14911.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4685.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4435.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4639.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15739.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14082.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4639.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9940.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4524.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4435.25,15739.6,
"ARTHREX UNIVERS REVERS MODULAR GLENOID SYSTEM, GLENOSPHERE 39/24",690466,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15336,,,10275.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4105.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13802.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4337.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4105.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4294.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14569.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13035.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4188.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4105.45,14569.2,
"ARTHREX UNIVERS REVERS MODULAR GLENOID SYSTEM, GLENOSPHERE 42+4 Lateralized, 24 mm baseplate taper,",690564,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15336,,,10275.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4105.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13802.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4337.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4105.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4294.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14569.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13035.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4188.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4105.45,14569.2,
"ARTHREX UNIVERS REVERS MODULAR GLENOID SYSTEM, PERIPHERAL SCREW LOCKING 5.5 X 16MM, SHOULDER IMPLANT",690463,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"ARTHREX UNIVERS REVERS MODULAR GLENOID SYSTEM, PERIPHERAL SCREW LOCKING 5.5 X 20MM, SHOULDER IMPLANT",690562,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"ARTHREX UNIVERS REVERS MODULAR GLENOID SYSTEM, PERIPHERAL SCREW LOCKING 5.5 X 24MM, SHOULDER IMPLANT",690464,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"ARTHREX UNIVERS REVERS MODULAR GLENOID SYSTEM, PERIPHERAL SCREW LOCKING 5.5 X 28MM, SHOULDER IMPLANT",690563,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"ARTHREX UNIVERS REVERS MODULAR GLENOID SYSTEM, PERIPHERAL SCREW LOCKING 5.5 X 36MM",690465,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"ARTHREX UNIVERS REVERS MODULAR GLENOID SYSTEM, PERIPHERAL SCREW, NON-LOCKING 4.5 X 36MM, SHOULDER IM",690473,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"Arthrex Univers Revers Modular Glenois System 33 +3",691522,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6768,,,4534.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1811.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3384,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6091.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1913.99,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1811.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1895.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6429.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5752.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1895.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4060.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1848.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1811.79,6429.6,
"Arthrex Univers Revers Monoblock Stem size 4/33 135?",691521,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,27260,,,18264.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7632.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7297.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7632.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13630,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",24534,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7709.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7297.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7632.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25897,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23171,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7632.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16356,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7444.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7297.5,25897,
"ARTHREX UNIVERS REVERS SUTURECUP 39, +2 RIGHT",690475,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,11900,,,7973,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3332,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3185.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3332,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5950,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10710,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3365.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3185.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3332,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11305,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10115,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3332,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7140,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3249.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3185.63,11305,
"ARTHREX UNIVERS REVERS SUTURECUP 42, +2 LEFT",690566,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,11900,,,7973,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3332,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3185.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3332,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5950,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10710,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3365.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3185.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3332,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11305,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10115,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3332,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7140,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3249.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3185.63,11305,
"Arthrex Univers Revers? Modular Glenoid System 24mm +2mm Lateralized Modular Baseplate, Shoulder imp",691526,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14668,,,9827.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4107.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3926.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4107.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7334,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13201.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4148.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3926.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4107.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13934.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12467.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4107.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8800.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4005.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3926.62,13934.6,
"Arthrex Univers Revers? Modular Glenoid System Glenoshpere 33mm +4mm Lateralized / 24 Shoulder impla",691527,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15336,,,10275.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4105.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7668,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13802.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4337.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4105.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4294.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14569.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13035.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4294.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9201.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4188.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4105.45,14569.2,
"Arthrex VAL KreuLock Comp. Screw, Titanium, 2.7 x 20 mm",691621,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex VAL KreuLock Comp. Screw, Titanium, 2.7 x 22 mm",691622,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex VAL KreuLock Comp. Screw, Titanium, 2.7 x 24 mm",691628,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex VAL KreuLock Comp. Screw, Titanium, 2.7 x 30 mm",691627,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex VAL KreuLock Comp. Screw, Titanium, 2.7 x 36 mm",691623,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex VAL KreuLock Screw, Titanium, 3.0 mm x 10 mm",691130,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"ARTHREX VAL KreuLock Screw, Titanium, 3.0 mm x 12 mm",690705,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex VAL KreuLock Screw, Titanium, 3.0 mm x 14 mm",691128,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex VAL KreuLock Screw, Titanium, 3.0 mm x 16 mm",691127,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"Arthrex VAL KreuLock Screw, Titanium, 3.0 mm x 18 mm",690707,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"ARTHREX VAL SCREW 2.4 X 8MM",690386,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,936,,,627.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",262.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",250.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",262.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",936,100,,,,,0,"fee schedule","100% of total billed charges",842.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",264.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",250.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",262.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",889.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",795.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",262.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",561.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",255.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",250.57,936,
"ARTHREX WASHER FOR 3.75MM SCREW",690610,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,334,,,223.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",93.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",89.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",93.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",334,100,,,,,0,"fee schedule","100% of total billed charges",300.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",94.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",89.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",93.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",317.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",283.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",93.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",200.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",91.22,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",89.41,334,
"Arthrodesis Nail System Nail, ?12mm X 210mm",691413,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,34110,,,22853.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9550.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9131.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9550.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17055,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",30699,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9646.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9131.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9550.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",32404.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",28993.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9550.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20466,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9315.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9131.25,32404.5,
"Arthrosurface 12 mm Articular Component 2.0 x 6.0mm offset",691676,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12764,,,8551.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3573.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3416.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3573.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6382,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11487.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3609.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3416.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3573.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12125.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10849.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3573.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7658.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3485.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3416.92,12125.8,
"Arthrosurface 15mm Articular Component DF 2.5mm x 4.5mm",663013,CDM,278,RC,L8642,HCPCS,"OUTPATIENT ",,,15264,,,10226.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4273.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4086.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4273.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7632,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13737.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4316.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4086.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4273.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14500.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12974.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4273.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9158.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4168.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4086.17,14500.8,
"Arthrosurface 9.5mm Taper Post",663012,CDM,278,RC,L8642,HCPCS,"OUTPATIENT ",,,2628,,,1760.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",735.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",703.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",735.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1314,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2365.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",703.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",735.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2496.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2233.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",735.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1576.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",717.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",703.52,2496.6,
"Arthrosurface HemiCAP?  7.0mm Taper Post",691675,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2524,,,1691.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",706.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",675.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",706.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1262,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2271.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",713.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",675.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",706.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2397.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2145.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",706.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1514.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",689.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",675.67,2397.8,
"Arthrosurface Phalangeal Fixation Component",663588,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5248,,,3516.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1404.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2624,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4723.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1484.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1404.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1469.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4985.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4460.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1469.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3148.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1433.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1404.89,4985.6,
"Arthrosurface Phalangeal Insert",664508,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12644,,,8471.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3540.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3384.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3540.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6322,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11379.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3575.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3384.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3540.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12011.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10747.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3540.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7586.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3453.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3384.8,12011.8,
"ASTURA ALTA SPACER TITANIUM",663984,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5600,,,3752,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1499.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5040,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1583.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1499.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1568,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5320,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4760,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3360,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1529.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1499.12,5320,
"ASTURA FACE PLATE 8MM",690169,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6000,,,4020,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1606.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1696.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1606.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1680,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5700,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5100,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1638.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1606.2,5700,
"ASTURA PLATE ZERO PROFILE 7MM",664609,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6000,,,4020,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1606.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1696.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1606.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1680,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5700,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5100,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1638.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1606.2,5700,
"ASTURA SCREW 3.5 X 12MM",690050,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1180,,,790.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",330.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",315.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",330.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",590,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1062,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",333.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",315.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",330.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1121,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1003,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",330.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",708,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",322.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",315.89,1121,
"ASTURA TI CAGE 14 X 12 X 8",690168,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6600,,,4422,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1766.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5940,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1866.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1766.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1848,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6270,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5610,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3960,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1802.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1766.82,6270,
"ASTURA ZION CERVICAL PLATE 2 LEVEL",663985,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5200,,,3484,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1456,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1392.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1456,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4680,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1470.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1392.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1456,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4940,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4420,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1456,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3120,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1420.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1392.04,4940,
"ASTURA ZION CERVICAL SCREW VAR 4.0",663986,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"ASTURE TITANIUM CAGE 14 X 12 X 7MM",664779,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6600,,,4422,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1766.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5940,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1866.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1766.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1848,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6270,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5610,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1848,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3960,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1802.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1766.82,6270,
"AVANCE NERVE  GRAFT 1-2 MM X 30MM",664330,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,18596,,,12459.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5206.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4978.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5206.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9298,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16736.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5258.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4978.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5206.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17666.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15806.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5206.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11157.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5078.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4978.15,17666.2,
"Avance Nerve Connector D=2mm L=15mm",690335,CDM,278,RC,C1763,HCPCS,"OUTPATIENT ",,,8908,,,5968.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2494.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2384.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2494.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4454,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8017.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2519.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2384.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2494.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8462.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7571.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2494.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5344.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2432.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2384.67,8462.6,
"Avance Nerve Connector D=3mm L=15mm",691006,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8560,,,5735.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2396.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2291.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2396.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4280,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7704,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2420.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2291.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2396.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8132,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7276,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2396.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5136,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2337.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2291.51,8132,
"AVANCE NERVE GRAFT 2MM X 2CM",664416,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,17276,,,11574.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4837.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4624.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4837.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8638,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15548.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4885.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4624.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4837.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",16412.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14684.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4837.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10365.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4718.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4624.79,16412.2,
"AVANCE NERVE GRAFT 4-5 X 70",663981,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,36240,,,24280.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10147.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9701.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10147.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",32616,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10248.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9701.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10147.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34428,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30804,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10147.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21744,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9897.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9701.45,34428,
"AVIVE SOFT TISSUE MEMBRANE 3 X 6",663983,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,15100,,,10117,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4228,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4042.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4228,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7550,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13590,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4270.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4042.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4228,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14345,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12835,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4228,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9060,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4123.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4042.27,14345,
"AXOGUARD NERVE CONDUIT 5 X 15 CM",663982,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,7120,,,4770.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1993.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1906.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1993.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3560,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6408,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2013.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1906.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1993.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6764,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6052,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1993.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4272,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1944.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1906.02,6764,
"AXOGUARD NERVE CONDUIT 5 X 40CM",663994,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,9880,,,6619.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2766.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2644.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2766.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4940,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8892,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2794.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2644.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2766.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9386,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8398,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2766.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5928,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2698.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2644.88,9386,
"AXOGUARD NERVE CONDUIT 7 X 40 CM",663993,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,10080,,,6753.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2822.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2698.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2822.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5040,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9072,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2850.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2698.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2822.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9576,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8568,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2822.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6048,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2752.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2698.42,9576,
"Azure S DR MRI Battery",691121,CDM,278,RC,C1785,HCPCS,"OUTPATIENT ",,,20636,,,13826.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5778.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5524.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5778.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10318,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18572.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5835.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5524.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5778.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19604.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17540.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5778.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12381.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5635.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5524.26,19604.2,
"BANDAGE COBAN 3",5019220,CDM,270,RC,A6245,HCPCS,"OUTPATIENT ",,,3.21,,,2.15,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.05,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.86,3.05,
"BANDAGE COBAN 4",5011000,CDM,270,RC,A6246,HCPCS,"OUTPATIENT ",,,4.02,,,2.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.62,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.41,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.08,3.82,
"BANDAGE COBAN 6",5020200,CDM,270,RC,A6243,HCPCS,"OUTPATIENT ",,,5.25,,,3.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.47,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4.46,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.47,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.15,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1.41,4.99,
"Bard Phasix  ST Mesh 15cm x 30cm",664132,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,34819.6,,,23329.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9749.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9321.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9749.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17409.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",31337.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9846.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9321.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9749.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",33078.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",29596.66,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9749.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20891.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9509.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9321.21,33078.62,
"BIOMET MINI FIXATOR LONG",663214,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7725,,,5175.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2163,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2067.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2163,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3862.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6952.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2184.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2067.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2163,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7338.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6566.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2163,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4635,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2109.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2067.98,7338.75,
"BIOMET PLATE DVR NAR STD",663260,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2200.76,,,1474.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",616.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",589.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",616.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1100.38,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1980.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",622.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",589.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",616.21,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2090.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1870.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",616.21,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1320.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",601.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",589.14,2090.72,
"BIONEST CORTICAL FIBERS SM",663971,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1500,,,1005,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",401.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1350,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",424.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",401.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",420,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1425,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1275,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges",900,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",409.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",401.55,1425,
"BIOVANCE ALLOGRAFT 4X4",664166,CDM,278,RC,Q4154,HCPCS,"OUTPATIENT ",,,14836,,,9940.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4154.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3971.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4154.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7418,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13352.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4195.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3971.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4154.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14094.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12610.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4154.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8901.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4051.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3971.6,14094.2,
"BONE ARTIFICIAL STRIPS PLIF",622007,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,10544,,,7064.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2952.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2822.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2952.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5272,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9489.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2981.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2822.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2952.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10016.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8962.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2952.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6326.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2879.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2822.63,10016.8,
"BONE CANCELLOUS SPONGE NEVOS",663559,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6000,,,4020,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1606.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1696.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1606.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1680,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5700,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5100,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1638.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1606.2,5700,
"BONE GRAFT EVO3 1.0CC",663694,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1430.8,,,958.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",400.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",383.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",400.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",715.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1287.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",404.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",383.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",400.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1359.26,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1216.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",400.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",858.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",390.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",383.03,1359.26,
"BONE GRAFT EVO3 5CC",663246,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4984,,,3339.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1395.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1334.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1395.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2492,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4485.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1409.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1334.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1395.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4734.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4236.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1395.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2990.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1361.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1334.22,4734.8,
"BOSTON SCIENTIFIC 50cm Trial Infinion 16 Lead Kit",663856,CDM,278,RC,C1897,HCPCS,"OUTPATIENT ",,,8000,,,5360,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2141.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2262.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2141.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2240,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7600,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6800,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2184.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2141.6,7600,
"BOSTON SCIENTIFIC 70cm Trial Infinion 16 Lead Kit",691355,CDM,278,RC,C1897,HCPCS,"OUTPATIENT ",,,8000,,,5360,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2141.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2262.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2141.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2240,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7600,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6800,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2184.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2141.6,7600,
"BRIEFS MEDIUM",5015026,CDM,270,RC,T4522,HCPCS,"OUTPATIENT ",,,13.2,,,8.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11.22,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.53,12.54,
"CANCELLOUS CHIPS 15CC",664291,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,864,,,578.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",241.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",231.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",241.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",864,100,,,,,0,"fee schedule","100% of total billed charges",777.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",244.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",231.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",241.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",820.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",734.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",241.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",518.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",235.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",231.29,864,
"Cancellous Plug 6 x11x14mm",690828,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"Cancellous Plug 7x11x14mm",690605,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"CAPTIVA TIRBOLOX CERVICAL CAGE",664034,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5600,,,3752,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1499.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5040,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1583.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1499.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1568,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5320,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4760,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3360,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1529.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1499.12,5320,
"CATH 12FR SILICONE 2-WAY",80001029,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,10.77,,,7.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10.23,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.88,10.23,
"CATH COUDE 18FR",5016153,CDM,272,RC,A4352,HCPCS,"OUTPATIENT ",,,80.94,,,54.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",22.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",21.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",22.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",72.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",21.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",22.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",76.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",68.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",22.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",48.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",22.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",21.67,76.89,
"CATH FOLEY 22FR 30CC SILICONE 2-WAY",80001030,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,15.27,,,10.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13.74,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.09,14.51,
"CATH FOLEY 3WAY 5CC 20FR/LATEX FREE",80043461,CDM,270,RC,A4346,HCPCS,"OUTPATIENT ",,,36.42,,,24.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",32.78,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9.75,34.6,
"CATH SILICONE 10FR 2 WAY",80001028,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,10.02,,,6.71,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.02,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.01,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.68,9.52,
"CATH SILICONE 14FR 2 WAY",80001020,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,9.45,,,6.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",8.51,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.65,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.65,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.67,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.53,8.98,
"CATH SILICONE 16FR 2-WAY",80001025,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,11.07,,,7.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.64,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.02,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.96,10.52,
"CATH SILICONE 18FR 2 WAY",80001021,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,18.3,,,12.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",16.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15.56,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10.98,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.9,17.39,
"CATH SILICONE 20FR 2WAY",80001022,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,8.97,,,6.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",8.07,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.4,8.52,
"CATH SILICONE 22FR 2-WAY",80001023,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,10.47,,,7.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",9.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2.8,9.95,
"CATH SILICONE 8FR 2-WAY",80001033,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,12.93,,,8.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10.99,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.46,12.28,
"CATH SILICONE FOLEY 24FR 30CC 2-WAY",80001031,CDM,270,RC,A4344,HCPCS,"OUTPATIENT ",,,14.85,,,9.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",13.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3.98,14.11,
"CC60WF LENS",690146,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,536,,,359.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",150.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",143.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",150.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",482.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",143.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",150.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",509.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",455.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",150.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",321.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",146.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",143.49,509.2,
"CCA0T3 Clarion Toric LENS",691404,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"CCW0T3 LENS",690650,CDM,278,RC,V2632,HCPCS,"OUTPATIENT ",,,1928,,,1291.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",964,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1735.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",545.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",516.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",539.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1831.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1638.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1156.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",526.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",516.13,1831.6,
"CCW0T4 LENS",690164,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,1928,,,1291.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1735.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",545.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",516.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",539.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1831.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1638.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1156.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",526.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",516.13,1831.6,
"CCW0T5 LENS",690165,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,1928,,,1291.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1735.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",545.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",516.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",539.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1831.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1638.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1156.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",526.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",516.13,1831.6,
"CCW0T6 LENS",690210,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,1928,,,1291.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1735.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",545.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",516.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",539.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1831.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1638.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",539.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1156.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",526.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",516.13,1831.6,
"CCWET0 LENS",690476,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,4060,,,2720.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1086.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3654,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1148.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1086.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1136.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3857,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3451,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2436,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1108.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1086.86,3857,
"CCWET3 LENS",690390,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,4060,,,2720.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1086.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3654,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1148.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1086.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1136.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3857,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3451,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2436,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1108.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1086.86,3857,
"CCWET4 LENS",690261,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,4060,,,2720.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1086.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3654,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1148.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1086.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1136.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3857,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3451,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2436,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1108.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1086.86,3857,
"CCWET5 LENS",690935,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,4060,,,2720.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1086.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3654,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1148.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1086.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1136.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3857,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3451,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2436,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1108.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1086.86,3857,
"CCWTT0 LENS",690318,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,4060,,,2720.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1086.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3654,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1148.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1086.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1136.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3857,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3451,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2436,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1108.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1086.86,3857,
"CCWTT3 LENS",690145,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,2537.5,,,1700.13,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",710.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",679.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",710.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2283.75,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",717.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",679.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",710.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2410.63,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2156.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",710.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1522.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",692.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",679.29,2410.63,
"CCWTT4 LENS",690887,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,4060,,,2720.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1086.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3654,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1148.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1086.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1136.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3857,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3451,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2436,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1108.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1086.86,3857,
"CCWTT6 LENS",690373,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,4060,,,2720.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1086.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3654,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1148.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1086.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1136.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3857,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3451,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1136.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2436,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1108.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1086.86,3857,
"CERAMENT? G with Gentamicin 10ml",690827,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,29748,,,19931.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8329.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7963.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8329.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14874,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",26773.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8412.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7963.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8329.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",28260.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",25285.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8329.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17848.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8124.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7963.54,28260.6,
"Cervical Spacer 7mm x 11mm x 14mm Allograft",691184,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"ChoisceSpine Cervical Graft 5 Deg 8mm",691517,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5600,,,3752,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1499.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5040,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1583.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1499.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1568,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5320,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4760,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3360,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1529.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1499.12,5320,
"Cortical Locking Screw 35  x 12mm",691631,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,252,,,168.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",252,100,,,,,0,"fee schedule","100% of total billed charges",226.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",239.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",214.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",151.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.46,252,
"CROSSROADS CROSSTIE MINI PEAK",663650,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5424,,,3634.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1518.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1452,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1518.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2712,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4881.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1533.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1452,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1518.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5152.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4610.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1518.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3254.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1481.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1452,5152.8,
"CROSSROADS DYNAFORCE SHORT PLATE",664036,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,10224,,,6850.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2862.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2736.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2862.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5112,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9201.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2891.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2736.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2862.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9712.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8690.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2862.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6134.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2792.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2736.96,9712.8,
"CROSSROADS HIMAX C Staple 18mm X 18mm X 18mm",691025,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5912,,,3961.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1655.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1582.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1655.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2956,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5320.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1671.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1582.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1655.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5616.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5025.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1655.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3547.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1614.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1582.64,5616.4,
"CROSSROADS HIMAX STAPLE 18mm X 18mm X 14mm",690792,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,10000,,,6700,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677,9500,
"CROSSROADS HIMAX STAPLE KIT",664037,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8624,,,5778.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2414.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2308.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2414.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4312,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7761.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2438.87,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2308.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2414.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8192.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7330.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2414.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5174.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2355.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2308.64,8192.8,
"CROSSROADS MOTOBAND LOCKING SCREW 3.0",664038,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,700,,,469,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",187.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",700,100,,,,,0,"fee schedule","100% of total billed charges",630,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",197.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",187.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",196,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",665,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",595,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",196,28,,,,,0,"percent of total billed charges ","28% of total billed charges",420,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",191.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",187.39,700,
"CrossRoads MotoBAND Non-Locking Screw 3.5mm x 18mm",691028,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,712,,,477.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",712,100,,,,,0,"fee schedule","100% of total billed charges",640.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",201.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",199.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",676.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",605.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",427.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",194.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.6,712,
"CrossRoads MotoBAND Non-Locking Screw 3.5mm x 22mm",691026,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,712,,,477.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",199.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",190.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",199.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",712,100,,,,,0,"fee schedule","100% of total billed charges",640.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",201.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",190.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",199.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",676.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",605.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",199.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",427.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",194.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",190.6,712,
"CrossRoads MotoBAND Polyaxial Locking Screw 3.5mm x 16mm",691027,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,784,,,525.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",209.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",784,100,,,,,0,"fee schedule","100% of total billed charges",705.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",221.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",209.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",219.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",744.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",470.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",214.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",209.88,784,
"CrossRoads MotoBAND Polyaxial Locking Screw 3.5mm x 18mm",691029,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,784,,,525.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",209.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",784,100,,,,,0,"fee schedule","100% of total billed charges",705.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",221.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",209.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",219.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",744.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",219.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",470.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",214.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",209.88,784,
"CROSSROADS SCREW SNAP-OFF",663514,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1360,,,911.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",364.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",680,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1224,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",384.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",364.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",380.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1292,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1156,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",816,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",371.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",364.07,1292,
"CS STALIF C ABO SCREW",663845,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1200,,,804,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",321.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1080,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",339.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",321.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",336,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1140,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1020,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges",720,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",327.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",321.24,1140,
"CS STALIF C CAGE",663846,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12000,,,8040,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3212.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3393.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3212.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3360,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11400,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10200,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3277.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3212.4,11400,
"CS TOWERLOK MIS CVD ROD",664083,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1200,,,804,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",321.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1080,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",339.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",321.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",336,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1140,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1020,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges",720,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",327.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",321.24,1140,
"CS TOWERLOK MIS SCREW",664082,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5600,,,3752,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1499.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5040,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1583.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1499.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1568,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5320,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4760,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3360,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1529.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1499.12,5320,
"CS TOWERLOK SET SCREW",664084,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"CYGNUS 10mm Anterior Cervical Plate - MoTi Level 1",664138,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6500,,,4355,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1740.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5850,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1838.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1740.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1820,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6175,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5525,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3900,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1775.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1740.05,6175,
"CYGNUS 12mm x 4.25mm Variable Self-Tapping Screw",690789,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"CYGNUS 14mm x 3.75mm Variable Self-Drilling Screw",664241,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"CYGNUS 22mm Anterior Cervical Plate - MoTi Level 2",690788,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7300,,,4891,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1954.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2064.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1954.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2044,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6935,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6205,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1993.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1954.21,6935,
"CYGNUS 30mm Anterior Cervical Plate - MoTi Level 2",690606,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7300,,,4891,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1954.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2064.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1954.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2044,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6935,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6205,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1993.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1954.21,6935,
"DERMABOND AMPULE TOPICAL SKIN",630720,CDM,272,RC,A6250,HCPCS,"OUTPATIENT ",,,28.77,,,19.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",25.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",24.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17.26,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7.7,27.33,
"DIAMOND CERVICAL PLATE 3 HOLE",663434,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8960,,,6003.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2508.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2398.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2508.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4480,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8064,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2533.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2398.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2508.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8512,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7616,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2508.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5376,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2446.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2398.59,8512,
"Digit Widget",691194,CDM,272,RC,C1889,HCPCS,"OUTPATIENT ",,,5175,,,3467.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1449,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1385.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1449,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4657.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1463.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1385.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1449,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4916.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4398.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1449,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3105,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1413.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1385.35,4916.25,
"Distal Tibia, Right Allograft",691383,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,27400,,,18358,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7334.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",24660,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7748.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7334.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26030,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23290,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7482.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7334.98,26030,
"DIU225 LENS",690260,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"DIU375 LENS",690834,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"DIU450 LENS Tecnis Eyhance Toric II IOL",691084,CDM,276,RC,V2787,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"DIU600 LENS",690619,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"Double Strand SemiTendinosus Graft",691656,CDM,278,RC,C1762,HCPCS,"OUTPATIENT ",,,8040,,,5386.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2251.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2152.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2251.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4020,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7236,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2273.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2152.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2251.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7638,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6834,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2251.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4824,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2195.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2152.31,7638,
"DRN00V LENS",691193,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,3980,,,2666.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1065.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3582,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1125.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1065.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1114.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3781,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3383,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2388,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1086.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1065.45,3781,
"DS 1.5MM DRILL BIT",690492,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,306,,,205.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",81.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",306,100,,,,,0,"fee schedule","100% of total billed charges",275.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",81.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",290.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",260.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",183.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",81.92,306,
"DS 2.0 TI CORTEX SCREW SELF TAPPING SD RECESS 11MM",690491,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,170.52,,,114.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",45.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.52,100,,,,,0,"fee schedule","100% of total billed charges",153.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",45.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",47.75,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",161.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",144.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges",102.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",46.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",45.65,170.52,
"DS 2.0 TI CORTEX SCREW SELF TAPPING SD RECESS 6MM",690490,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,170.52,,,114.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",47.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",45.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",47.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.52,100,,,,,0,"fee schedule","100% of total billed charges",153.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",45.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",47.75,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",161.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",144.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",47.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges",102.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",46.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",45.65,170.52,
"DS 2.0 TI VAL CONDYLAR PLATE 2 HOLES HEAD 6 HOLES SHAFT",690489,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2667,,,1786.89,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",746.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",713.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",746.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1333.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2400.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",754.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",713.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",746.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2533.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2266.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",746.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1600.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",728.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",713.96,2533.65,
"DS 2.0 X 11 mm Variable Angle Locking Screw",690493,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,616.76,,,413.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",616.76,100,,,,,0,"fee schedule","100% of total billed charges",555.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",585.92,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.11,616.76,
"DS 2.0 X 12 mm Variable Angle Locking Screw",690494,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,616.76,,,413.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",616.76,100,,,,,0,"fee schedule","100% of total billed charges",555.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",585.92,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.11,616.76,
"DS 2.0 X 13 mm Variable Angle Locking Screw",690495,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,616.76,,,413.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",616.76,100,,,,,0,"fee schedule","100% of total billed charges",555.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",585.92,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.11,616.76,
"DS 2.0 X 15 mm Variable Angle Locking Screw",690496,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,616.76,,,413.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",616.76,100,,,,,0,"fee schedule","100% of total billed charges",555.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",585.92,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.11,616.76,
"DS 2.00MM TI VAL STRAIGHT PLATE 12 HOLES",690488,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2493,,,1670.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",698.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",667.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",698.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1246.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2243.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",705.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",667.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",698.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2368.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2119.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",698.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1495.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",680.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",667.38,2368.35,
"DS 2.7 mm LCP Plate, straight, 6 holes",690878,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2064.84,,,1383.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",578.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",552.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",578.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1032.42,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1858.36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",583.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",552.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",578.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1961.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1755.11,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",578.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1238.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",563.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",552.76,1961.6,
"DS 2.7/3.5mm VA-LCP Anteromedial Distal Tibia Plate",691007,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8527.2,,,5713.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2387.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2282.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2387.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4263.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7674.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2411.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2282.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2387.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8100.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7248.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2387.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5116.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2328.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2282.73,8100.84,
"DS 2.7mm  x 30mm Metaphyseal Screw, Self-Tapping",691008,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,246.28,,,165.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",68.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",65.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",68.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",246.28,100,,,,,0,"fee schedule","100% of total billed charges",221.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",65.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",68.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",233.97,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",209.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",68.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",147.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",65.93,246.28,
"DS 2.7MM CORTEX SCREW SELF-TAPPING 24MM",690856,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,200.12,,,134.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.12,100,,,,,0,"fee schedule","100% of total billed charges",180.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",190.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",170.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",120.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.57,200.12,
"DS 2.7MM CORTEX SCREW SELF-TAPPING 28MM",690857,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,200.12,,,134.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.12,100,,,,,0,"fee schedule","100% of total billed charges",180.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",190.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",170.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",120.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.57,200.12,
"DS 2.7mm x 32mm Variable Angle Locking Screw, Self-Tapping",691009,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,724.6,,,485.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",193.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",724.6,100,,,,,0,"fee schedule","100% of total billed charges",652.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",204.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",193.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",202.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",688.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",615.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",434.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",197.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",193.98,724.6,
"DS 2.7mm x 36mm Variable Angle Locking Screw, Self-Tapping",691010,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,724.6,,,485.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",193.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",724.6,100,,,,,0,"fee schedule","100% of total billed charges",652.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",204.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",193.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",202.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",688.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",615.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",434.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",197.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",193.98,724.6,
"DS 2.7mm x 40mm Variable Angle Locking Screw, Self-Tapping",691011,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,724.6,,,485.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",193.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",724.6,100,,,,,0,"fee schedule","100% of total billed charges",652.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",204.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",193.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",202.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",688.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",615.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",434.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",197.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",193.98,724.6,
"DS 2.7mm x 48mm Variable Angle Locking Screw, Self-Tapping",691012,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,724.6,,,485.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",193.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",724.6,100,,,,,0,"fee schedule","100% of total billed charges",652.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",204.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",193.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",202.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",688.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",615.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",434.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",197.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",193.98,724.6,
"DS 2.7mm x 50mm Variable Angle Locking Screw, Self-Tapping",691013,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,724.6,,,485.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",193.98,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",724.6,100,,,,,0,"fee schedule","100% of total billed charges",652.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",204.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",193.98,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",202.89,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",688.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",615.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",202.89,28,,,,,0,"percent of total billed charges ","28% of total billed charges",434.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",197.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",193.98,724.6,
"DS 3.5 LCP Reconstruction 10 Hole Straight Plate",691668,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3353.8,,,2247.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",939.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",897.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",939.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1676.9,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3018.42,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",948.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",897.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",939.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3186.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2850.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",939.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2012.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",915.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",897.81,3186.11,
"DS 3.5 mm x 20mm Locking Screws, self-tapping, with StarDrive Recess",690860,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,769.32,,,515.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",769.32,100,,,,,0,"fee schedule","100% of total billed charges",692.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",730.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",653.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",461.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",210.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.95,769.32,
"DS 3.5 mm x 22mm Locking Screws, self-tapping, with StarDrive Recess",690502,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,635.64,,,425.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",635.64,100,,,,,0,"fee schedule","100% of total billed charges",572.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",179.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",170.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",177.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",603.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",540.29,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",381.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",173.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",170.16,635.64,
"DS 3.5 mm X 24mm Cortex Screws, self-tapping, with hex recess",690499,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,109.88,,,73.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.88,100,,,,,0,"fee schedule","100% of total billed charges",98.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.41,109.88,
"DS 3.5 mm x 24mm Locking Screws, self-tapping, with StarDrive Recess",690501,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,635.64,,,425.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",635.64,100,,,,,0,"fee schedule","100% of total billed charges",572.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",179.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",170.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",177.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",603.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",540.29,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",381.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",173.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",170.16,635.64,
"DS 3.5 mm X 26mm Cortex Screws, self-tapping",690858,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,109.88,,,73.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.88,100,,,,,0,"fee schedule","100% of total billed charges",98.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.41,109.88,
"DS 3.5 mm x 26mm Locking Screws, self-tapping, with StarDrive Recess",690861,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,635.64,,,425.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",635.64,100,,,,,0,"fee schedule","100% of total billed charges",572.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",179.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",170.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",177.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",603.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",540.29,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",177.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",381.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",173.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",170.16,635.64,
"DS 3.5 mm X 28mm Cortex Screws, self-tapping",690859,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,155.72,,,104.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",155.72,100,,,,,0,"fee schedule","100% of total billed charges",140.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",147.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.69,155.72,
"DS 3.5mm x 100mm Pelvic Cortex Screw, Self-Tapping",691018,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,145.56,,,97.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",145.56,100,,,,,0,"fee schedule","100% of total billed charges",131,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",123.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.97,145.56,
"DS 3.5mm x 30mm Cortex Screw, Self-Tapping",691016,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,155.72,,,104.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",155.72,100,,,,,0,"fee schedule","100% of total billed charges",140.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",147.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.69,155.72,
"DS 3.5mm x 65mm Pelvic Cortex Screw, Self-Tapping",691017,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,145.56,,,97.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",145.56,100,,,,,0,"fee schedule","100% of total billed charges",131,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",138.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",123.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.97,145.56,
"DS 4.0MM CANNULATED SCREW SHORT THREADED 48MM",690813,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,980.4,,,656.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",980.4,100,,,,,0,"fee schedule","100% of total billed charges",882.36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",931.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",833.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",588.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.45,980.4,
"DS 4.0mm X  44mm Cannulated Screw Short Thread",690520,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,930,,,623.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",930,100,,,,,0,"fee schedule","100% of total billed charges",837,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",260.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",883.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",790.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",558,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.96,930,
"DS 4.0mm x 30mm Cannulated Screw Short Thread",691214,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,980.4,,,656.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",980.4,100,,,,,0,"fee schedule","100% of total billed charges",882.36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",931.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",833.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",588.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.45,980.4,
"DS 4mm x 50mm Cannulated Screw",691061,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,980.4,,,656.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",980.4,100,,,,,0,"fee schedule","100% of total billed charges",882.36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",931.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",833.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",588.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.45,980.4,
"DS CANNULATED SCREW 4 X 32MM",690333,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,930,,,623.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",930,100,,,,,0,"fee schedule","100% of total billed charges",837,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",260.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",883.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",790.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",558,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.96,930,
"DS CANNULATED SCREW 4.5 X 44MM",690482,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,981,,,657.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",981,100,,,,,0,"fee schedule","100% of total billed charges",882.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",931.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",833.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",588.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.61,981,
"DS CANNULATED SCREW 4.5 X 48MM",690448,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,981,,,657.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",981,100,,,,,0,"fee schedule","100% of total billed charges",882.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",931.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",833.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",588.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.61,981,
"DS CANNULATED SCREW 4.5 X 52MM",690446,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,981,,,657.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",981,100,,,,,0,"fee schedule","100% of total billed charges",882.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",931.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",833.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",588.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.61,981,
"DS CANNULATED SCREW LONG THREAD 4.0 X 36MM",690400,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,930,,,623.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",930,100,,,,,0,"fee schedule","100% of total billed charges",837,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",260.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",883.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",790.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",558,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.96,930,
"DS CANNULATED SCREW SHORT THREAD 4.0 X 38MM",690399,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,930,,,623.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",930,100,,,,,0,"fee schedule","100% of total billed charges",837,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",260.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",883.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",790.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",558,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.96,930,
"DS CANNULATED SCREW SHORT THREAD 4.0 X 40MM",690398,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,930,,,623.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",930,100,,,,,0,"fee schedule","100% of total billed charges",837,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",260.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",883.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",790.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",558,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.96,930,
"DS CANNULATED SCREW SHORT THREAD 4.0 X 42MM",690397,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,930,,,623.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",930,100,,,,,0,"fee schedule","100% of total billed charges",837,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",260.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",883.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",790.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",260.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",558,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.96,930,
"DS CLAVICLE PLATE SHAFT 2.7 VA RIGHT",690316,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5070,,,3396.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1419.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1357.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1419.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2535,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4563,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1433.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1357.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1419.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4816.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4309.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1419.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3042,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1384.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1357.24,4816.5,
"DS ELASTIC NAIL 2MM",664317,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1329,,,890.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",355.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",664.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1196.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",375.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",355.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",372.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1262.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1129.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",797.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",355.77,1262.55,
"DS Extra-Articular Distal Humerus Plate, 3.5 mm X 158 mm 6 Holes, Left",690853,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7077.56,,,4741.97,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1981.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1894.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1981.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3538.78,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6369.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2001.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1894.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1981.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6723.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6015.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1981.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4246.54,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1932.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1894.66,6723.68,
"DS FLEX NAIL 2MM X 440MM",690321,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1329,,,890.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",355.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",664.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1196.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",375.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",355.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",372.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1262.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1129.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",372.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",797.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",355.77,1262.55,
"DS LCP One-Third Tubular Plates, with collar 8 holes",690497,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,861,,,576.87,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",241.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",230.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",241.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",861,100,,,,,0,"fee schedule","100% of total billed charges",774.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",243.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",230.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",241.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",817.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",731.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",241.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",516.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",235.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",230.49,861,
"DS METAPHYSEAL SCREW 16MM",690320,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,217.32,,,145.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",60.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",58.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",60.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",217.32,100,,,,,0,"fee schedule","100% of total billed charges",195.59,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",61.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",58.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",60.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",206.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",184.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",60.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",130.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",59.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",58.18,217.32,
"DS-MITEK BIO-INTRAFIX TAP SCREW",663928,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1560,,,1045.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",436.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",417.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",436.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",780,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1404,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",441.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",417.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",436.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1482,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1326,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",436.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",936,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",426.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",417.61,1482,
"DS-MITEK BIO-INTRAFIX TIB SHEATH",663927,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1656,,,1109.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",443.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",828,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1490.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",443.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",463.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1573.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1407.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",463.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",993.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",452.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",443.31,1573.2,
"DS-MITEK MICRO QUICKANCHOR + 3/0",664055,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2128,,,1425.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",595.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",569.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",595.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1064,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1915.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",601.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",569.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",595.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2021.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1808.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",595.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1276.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",581.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",569.67,2021.6,
"DS-MITEK MINI QUICKANCHOR PLUS 2/0 SUTUR",663626,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2364,,,1583.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",661.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",632.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",661.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1182,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2127.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",668.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",632.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",661.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2245.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2009.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",661.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1418.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",645.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",632.84,2245.8,
"DS-MITEK RIGIDLOOP CORT FIX IMPLANT",663926,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2048,,,1372.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",573.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",548.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",573.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1024,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1843.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",579.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",548.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",573.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1945.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1740.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",573.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1228.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",559.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",548.25,1945.6,
"DURA-GEN PLUS 1 X 3",664328,CDM,278,RC,C1763,HCPCS,"OUTPATIENT ",,,1350,,,904.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",378,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",361.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",378,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",675,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1215,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",381.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",361.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",378,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1282.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1147.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",378,28,,,,,0,"percent of total billed charges ","28% of total billed charges",810,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",368.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",361.4,1282.5,
"DynaBunion Plate STD 18mm-LEFT",691024,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9940,,,6659.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2783.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2660.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2783.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4970,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8946,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2811.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2660.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2783.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9443,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8449,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2783.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5964,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2714.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2660.94,9443,
"E0336 RBC CPD AS1 500 LR",2250011,CDM,390,RC,P9016,HCPCS,"OUTPATIENT ",,,382,,,255.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",102.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",343.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",102.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",362.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",324.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",229.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",104.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",102.26,362.9,
"E0378 RBC CP2D AS3 500 Irr",2250011,CDM,390,RC,P9040,HCPCS,"OUTPATIENT ",,,446.88,,,299.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",402.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",424.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",268.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.63,424.54,
"E0379 RBC CP2D AS3 500 LR Irr",2250011,CDM,390,RC,P9040,HCPCS,"OUTPATIENT ",,,446.88,,,299.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",402.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",424.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",268.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.63,424.54,
"E0382 RBC CP2D AS3 500 LR",2250001,CDM,391,RC,P9016,HCPCS,"OUTPATIENT ",,,496.5,,,332.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",139.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",132.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",139.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",446.85,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",140.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",132.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",139.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",471.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",422.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",139.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",297.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",135.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",132.91,471.68,
"E1624 Aph Plasma ACDA <24h",2250006,CDM,390,RC,P9017,HCPCS,"OUTPATIENT ",,,307,,,205.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",82.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",276.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",82.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",291.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",260.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",184.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",82.18,291.65,
"E2284 Thawed Aph Plasma ACDA <24h",2250006,CDM,390,RC,P9017,HCPCS,"OUTPATIENT ",,,307,,,205.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",82.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",276.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",82.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",291.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",260.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",184.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",82.18,291.65,
"E2284 Thawed Aph Plasma ACDA <24h Dv",2250006,CDM,390,RC,P9017,HCPCS,"OUTPATIENT ",,,307,,,205.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",82.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",276.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",82.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",291.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",260.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",184.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",82.18,291.65,
"E2619 Plasma CP2D <24h",2250006,CDM,390,RC,P9017,HCPCS,"OUTPATIENT ",,,307,,,205.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",82.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",276.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",82.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",291.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",260.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",184.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",82.18,291.65,
"E2737 Thawed Plasma CP2D <24h",2250006,CDM,390,RC,P9017,HCPCS,"OUTPATIENT ",,,307,,,205.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",82.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",276.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",82.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",85.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",291.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",260.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",85.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",184.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",83.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",82.18,291.65,
"E2862 Plt CP2D 500 Irr",2250010,CDM,390,RC,P9037,HCPCS,"OUTPATIENT ",,,1684.54,,,1128.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",450.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1516.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",476.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",450.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",471.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1600.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1431.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1010.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",460.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",450.95,1600.31,
"E2863 Plt CP2D 500 LR Irr",2250010,CDM,390,RC,P9037,HCPCS,"OUTPATIENT ",,,1684.54,,,1128.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",450.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1516.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",476.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",450.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",471.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1600.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1431.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1010.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",460.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",450.95,1600.31,
"E3077 Aph Plt ACDA LR",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3087 Aph Plt ACDA LR 1",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3088 Aph Plt ACDA LR 2",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3089 Aph Plt ACDA LR 3",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3102 Aph Plt ACDA 1",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3541 Aph Plt Washed LR Irr",2250010,CDM,390,RC,P9037,HCPCS,"OUTPATIENT ",,,1684.54,,,1128.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",450.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1516.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",476.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",450.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",471.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1600.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1431.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1010.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",460.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",450.95,1600.31,
"E3543 Aph Plt Washed LR Irr 1",2250010,CDM,390,RC,P9037,HCPCS,"OUTPATIENT ",,,1684.54,,,1128.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",450.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1516.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",476.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",450.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",471.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1600.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1431.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1010.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",460.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",450.95,1600.31,
"E3544 Aph Plt Washed LR Irr 2",2250010,CDM,390,RC,P9037,HCPCS,"OUTPATIENT ",,,1684.54,,,1128.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",450.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1516.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",476.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",450.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",471.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1600.31,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1431.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",471.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1010.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",460.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",450.95,1600.31,
"E3556 Aph Plt Washed LR",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3558 Aph Plt Washed LR 1",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3559 Aph Plt Washed LR 2",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3560 Aph Plt Washed LR 3",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E3591 Thawed Pooled Cryo",2250008,CDM,390,RC,P9012,HCPCS,"OUTPATIENT ",,,103,,,69.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",92.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",97.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",87.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",61.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.57,97.85,
"E3592 Thawed Pooled Cryo Open",2250008,CDM,390,RC,P9012,HCPCS,"OUTPATIENT ",,,103,,,69.01,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",27.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",92.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",27.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",28.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",97.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",87.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",28.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",61.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",28.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",27.57,97.85,
"E4526 Aph RBC ACDA AS1 LR Irr",2250011,CDM,390,RC,P9040,HCPCS,"OUTPATIENT ",,,446.88,,,299.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",402.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",424.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",268.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.63,424.54,
"E4527 Aph RBC ACDA AS1 LR Irr 1",2250011,CDM,390,RC,P9040,HCPCS,"OUTPATIENT ",,,446.88,,,299.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",402.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",424.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",268.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.63,424.54,
"E4528 Aph RBC ACDA AS1 LR Irr 2",2250011,CDM,390,RC,P9040,HCPCS,"OUTPATIENT ",,,446.88,,,299.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",402.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",424.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",268.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.63,424.54,
"E4531 Aph RBC ACDA AS1 LR",2250001,CDM,391,RC,P9016,HCPCS,"OUTPATIENT ",,,382,,,255.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",102.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",343.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",102.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",362.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",324.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",229.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",104.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",102.26,362.9,
"E4532 Aph ARBC ACDA AS1 LR 1",2250001,CDM,391,RC,P9016,HCPCS,"OUTPATIENT ",,,382,,,255.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",102.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",343.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",102.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",362.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",324.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",229.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",104.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",102.26,362.9,
"E4532 Aph RBC ACDA AS1 LR 1",2250001,CDM,391,RC,P9016,HCPCS,"OUTPATIENT ",,,382,,,255.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",102.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",343.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",102.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",362.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",324.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",229.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",104.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",102.26,362.9,
"E4533 Aph RBC ACDA AS1 LR 2",2250001,CDM,391,RC,P9016,HCPCS,"OUTPATIENT ",,,382,,,255.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",102.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",343.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",102.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",362.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",324.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",229.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",104.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",102.26,362.9,
"E4538 Aph RBC ACDA AS3 LR Irr",2250011,CDM,390,RC,P9040,HCPCS,"OUTPATIENT ",,,446.88,,,299.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",402.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",424.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",268.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.63,424.54,
"E4539 Aph RBC ACDA AS3 LR Irr 1",2250011,CDM,390,RC,P9040,HCPCS,"OUTPATIENT ",,,446.88,,,299.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",402.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",424.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",268.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.63,424.54,
"E4540 Aph RBC ACDA AS3 LR Irr 2",2250011,CDM,390,RC,P9040,HCPCS,"OUTPATIENT ",,,446.88,,,299.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",119.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",402.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",119.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",125.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",424.54,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",379.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",125.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",268.13,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",122.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",119.63,424.54,
"E4564 Aph RBC Washed LR 1",2250001,CDM,391,RC,P9016,HCPCS,"OUTPATIENT ",,,382,,,255.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",102.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",343.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",102.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",362.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",324.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",229.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",104.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",102.26,362.9,
"E4565 Aph RBC Washed LR 2",2250001,CDM,391,RC,P9016,HCPCS,"OUTPATIENT ",,,382,,,255.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",102.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",343.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",102.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",362.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",324.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",229.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",104.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",102.26,362.9,
"E4566 Aph RBC Washed 1",2250001,CDM,391,RC,P9016,HCPCS,"OUTPATIENT ",,,382,,,255.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",102.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",343.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",102.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",106.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",362.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",324.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",106.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",229.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",104.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",102.26,362.9,
"E4689 Aph FFP ACDA 1",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E5032 Aph Plt ACDA LR Bm 2",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E7001 Aph Plt ACDA PASC LR",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E7003 Aph Plt ACDA PASC LR 2",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E8340 Aph Plt ACDA>PASC LR Psoralen",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E8341 Aph Plr ACDA>PASC LR Psoralen 1",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E8342 Aph Plr ACDA>PASC LR Psoralen 2",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"E8343 Aph Plt ACDA>PASC LR Psoralen 3",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"EA154 Aph Plts ACDA>PASC IrrLR BM>=36h 2",2250005,CDM,390,RC,P9035,HCPCS,"OUTPATIENT ",,,641.28,,,429.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",171.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",577.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",171.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",179.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",609.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",545.09,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",179.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",384.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",175.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",171.67,609.22,
"EFMC EOVIST",2497501,CDM,250,RC,A9581,HCPCS,"OUTPATIENT ",,,40.2,,,26.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",36.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",11.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",38.19,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",34.17,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",24.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10.76,38.19,
"EFMC GADAVIST",2500327,CDM,636,RC,A9585,HCPCS,"OUTPATIENT ",,,249,,,166.83,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",249,100,,,,,0,"fee schedule","100% of total billed charges",224.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",236.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",211.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",149.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.66,249,
"EFMC LEXISCAN",2501236,CDM,250,RC,J2785,HCPCS,"OUTPATIENT ",,,901,,,603.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",252.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.81,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",252.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",810.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",3.74,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",254.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.81,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",252.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",855.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",765.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",252.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",540.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.89,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",3.74,855.95,
"EPIFIX ALLOGRAFT 2CM X 3CM",663460,CDM,278,RC,Q4186,HCPCS,"OUTPATIENT ",,,4780,,,3202.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1338.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1279.61,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1338.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2390,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4302,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1351.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1279.61,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1338.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4541,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4063,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1338.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2868,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1305.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1279.61,4541,
"EVOLOGIC AMNION PATCH 4X4 CM",664059,CDM,278,RC,Q4100,HCPCS,"OUTPATIENT ",,,7100,,,4757,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1988,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1900.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1988,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3550,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6390,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2007.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1900.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1988,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6745,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6035,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1988,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4260,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1939.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1900.67,6745,
"EVOLOGIC MESH ACELLULAR DERMIS 1.0CM",663938,CDM,278,RC,Q4128,HCPCS,"OUTPATIENT ",,,6000,,,4020,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1606.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1696.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1606.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1680,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5700,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5100,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1638.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1606.2,5700,
"EVOLOGICS AMNION FLUID 0.5ML",664076,CDM,278,RC,Q4137,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"EVOLOGICS AMNION PATCH 4 X 6 CM",664075,CDM,278,RC,Q4137,HCPCS,"OUTPATIENT ",,,9000,,,6030,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2520,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2409.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2520,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8100,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2545.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2409.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2520,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8550,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7650,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2520,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5400,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2457.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2409.3,8550,
"EXSOMED INNATE IMPLANT 3.6 X 40MM",663998,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2900,,,1943,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",776.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1450,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2610,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",820.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",776.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",812,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2755,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2465,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",812,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1740,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",791.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",776.33,2755,
"FastThread PEEK Interference Screw 9 mm ? 20 mm screw",690936,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1968,,,1318.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",984,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1771.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",526.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",551.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1869.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1672.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",551.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1180.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",537.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",526.83,1869.6,
"FiberTak SpeedBridge Implant System: 4.75 BioComposite Swivelock C Anchors",691487,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,16036,,,10744.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4490.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4292.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4490.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8018,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",14432.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4534.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4292.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4490.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15234.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13630.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4490.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9621.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4379.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4292.84,15234.2,
"FLEX-THREAD FIBULA NAIL 4.5 X 130MM",690396,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9835,,,6589.45,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2753.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2632.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2753.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4917.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8851.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2781.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2632.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2753.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9343.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8359.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2753.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5901,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2685.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2632.83,9343.25,
"FLEX-THREAD ZERO PROFILE LOCKING SCREW 2.7 X 16MM",690402,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,720,,,482.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",201.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",192.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",201.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",720,100,,,,,0,"fee schedule","100% of total billed charges",648,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",203.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",192.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",201.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",684,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",612,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",201.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",432,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",196.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",192.74,720,
"FLUID D5W 1000ML",80085011,CDM,636,RC,J7070,HCPCS,"OUTPATIENT ",,,4.98,,,3.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3.6,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.98,100,,,,,0,"fee schedule","100% of total billed charges",4.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3.6,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",1.39,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4.73,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",3.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",4.23,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3.67,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",1.39,4.98,
"FLUID IV D5.09 NACL 1000ML",5085007,CDM,250,RC,J7042,HCPCS,"OUTPATIENT ",,,4.38,,,2.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.94,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",2.51,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1.18,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",1.23,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",1.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",3.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.23,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.63,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.2,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",1.18,4.16,
"FLUID IV LR 1000ML",5085004,CDM,258,RC,J7120,HCPCS,"OUTPATIENT ",,,6,,,4.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",43.85,104,,,,,0,"fee schedule ","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.41,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",1.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",2.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",5.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.46,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",1.68,43.85,
"FUSION FUSEFIX SCREW HEADLESS 2.5MM",664095,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1220,,,817.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",341.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",326.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",341.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",610,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1098,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",345.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",326.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",341.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1159,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1037,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",341.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",732,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",333.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",326.59,1159,
"G0008 ADMIN OF INFLUENZA VACCINE CHARGE",4000081,CDM,771,RC,G0008,HCPCS,"OUTPATIENT ",,,74,,,49.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",66.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",70.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",62.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",44.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.81,70.3,
"G0009 ADMIN OF PNEUMOCOCCAL VACCINE CHARGE",4000091,CDM,771,RC,G0009,HCPCS,"OUTPATIENT ",,,74,,,49.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",66.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",70.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",62.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",44.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",20.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.81,70.3,
"G0105 COLONOSCOPY ON HIGH RISK IND",6G0105,CDM,750,RC,G0105,HCPCS,"OUTPATIENT ",,,6089.66,,,4080.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1705.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1630.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1705.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",5480.69,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1722.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1630.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1705.1,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5785.18,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5176.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1705.1,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3653.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1663.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1630.2,5785.18,
"G0121 COLONSCOPY NOT HIGH RISK ind",6G0121,CDM,750,RC,G0121,HCPCS,"OUTPATIENT ",,,4259.7,,,2854,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1192.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1140.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1192.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3833.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,2200.42,2194.82,2333.55,"1 through 10",other,"not separately reimbursment",1204.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1140.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1192.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4046.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3620.75,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1192.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2555.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1163.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1140.32,4046.72,
"G0168 WOUND CLOSURE BY ADHESIVE TechFee",250168,CDM,450,RC,G0168,HCPCS,"OUTPATIENT ",,,54.9,,,36.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",49.41,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15.37,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",52.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",46.67,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15.37,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32.94,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14.7,52.16,
"G0268 Removal of impacted wax md",202680,CDM,450,RC,G0268,HCPCS,"OUTPATIENT ",,,64,,,42.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",57.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",60.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",54.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",38.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",17.13,60.8,
"G0283 OT E STIMULATION UNATTENDED NON WND ASSISTANT CHARGE",44114459,CDM,430,RC,G0283,HCPCS,"OUTPATIENT ",,,156,,,104.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",140.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.76,148.2,
"G0283 OT E STIMULATION UNATTENDED NON WND CHARGE",4411445,CDM,430,RC,G0283,HCPCS,"OUTPATIENT ",,,156,,,104.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",140.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.76,148.2,
"G0283 UNATTENDED ESTIM ASSISTANT CHARGE",46014459,CDM,420,RC,G0283,HCPCS,"OUTPATIENT ",,,173.03,,,115.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",48.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",48.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",155.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",46.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",48.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",164.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",147.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",48.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",103.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",47.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.32,164.38,
"G0283 UNATTENDED ESTIM CHARGE",4601445,CDM,420,RC,G0283,HCPCS,"OUTPATIENT ",,,173.03,,,115.93,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",48.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",46.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",48.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",155.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",46.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",48.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",164.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",147.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",48.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",103.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",47.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",46.32,164.38,
"GAUZE SPONGE 2X2 STERILE 2 PK",5045234,CDM,272,RC,A6402,HCPCS,"OUTPATIENT ",,,15.66,,,10.49,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",14.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.19,14.88,
"GENESIS II CONSTRAINED ARTICULAR INSERT 13MM SIZE 3-4",690802,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"GENESIS II CONSTRAINED ARTICULAR INSERT 18MM SIZE 3-4",690902,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"GENESIS II LEFT NON POROUS TIBIAL BASEPLATE",690226,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"GENESIS II RESURFACING PATELLAR COMPONENT 35MM",690801,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6684,,,4478.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1871.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1789.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1871.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3342,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6015.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1890.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1789.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1871.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6349.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5681.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1871.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4010.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1825.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1789.31,6349.8,
"GENESIS II RESURFACING PATELLAR COMPONENT 35MM, 7.5MM THICK",690905,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5320,,,3564.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1424.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2660,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4788,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1504.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1424.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1489.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5054,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4522,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3192,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1452.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1424.16,5054,
"GI BALLOON CATH DILATOR 12-15 NON VASC",610140,CDM,272,RC,C1726,HCPCS,"OUTPATIENT ",,,705,,,472.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",188.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",634.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",188.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",669.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",599.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",423,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",188.73,669.75,
"GI BALLOON CATH DILATOR 15-18 NON VASC",610136,CDM,272,RC,C1726,HCPCS,"OUTPATIENT ",,,160.65,,,107.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",44.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",43.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",44.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",144.59,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.43,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",43.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",44.98,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",152.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",136.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",44.98,28,,,,,0,"percent of total billed charges ","28% of total billed charges",96.39,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",43.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",43.01,152.62,
"GRACILIS TENDON",690079,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,5813.16,,,3894.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1627.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1556.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1627.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2906.58,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5231.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1643.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1556.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1627.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5522.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4941.19,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1627.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3487.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1587.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1556.18,5522.5,
"GUIDEWIRE STD ZIPWIRE .038",663101,CDM,272,RC,C1769,HCPCS,"OUTPATIENT ",,,131.1,,,87.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",36.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",35.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",36.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",117.99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",35.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",36.71,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",124.55,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",111.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",36.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges",78.66,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",35.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",35.1,124.55,
"I-FACTOR BONE GRAFT 1CC",663767,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3000,,,2010,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",803.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2700,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",848.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",803.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",840,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2850,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2550,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",840,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",819.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",803.1,2850,
"I-FACTOR BONE GRAFT 2.5CC",663777,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"I-FACTOR BONE GRAFT 5.0CC",663906,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,10000,,,6700,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2677,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2828,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2677,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2800,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9500,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8500,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2800,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2731,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2677,9500,
"Inbone Poly Insert Sulcus size 2",691590,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15311.28,,,10258.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4098.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7655.64,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13780.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4330.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4098.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4287.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14545.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13014.59,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9186.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4181.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4098.83,14545.72,
"INFINITY ADAPTIS TALAR DOME FLAT CUT SIZE 2",690256,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20672.5,,,13850.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5788.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5534.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5788.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10336.25,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18605.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5846.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5534.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5788.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19638.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17571.63,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5788.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12403.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5645.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5534.03,19638.88,
"INFINITY ADAPTIS TALAR DOME FLAT CUT SIZE 4",690357,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,33076,,,22160.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9261.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8854.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9261.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16538,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",29768.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9353.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8854.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9261.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",31422.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",28114.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9261.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",19845.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9033.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8854.45,31422.2,
"INFINITY ADAPTIS TIBIAL TRAY  3 LONG",690674,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,31172,,,20885.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8344.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15586,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",28054.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8815.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8344.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8728.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29613.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",26496.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18703.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8513.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8344.74,29613.4,
"INFINITY EVERLAST CROSS-LINKED POLY INSERT SIZE 2+, H 6MM",690258,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15176,,,10167.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4249.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4062.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4249.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7588,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13658.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4291.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4062.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4249.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14417.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12899.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4249.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9105.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4144.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4062.62,14417.2,
"INFINITY TRAY TIBIAL BIOFOAM SIZE 3",690254,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,31172,,,20885.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8344.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15586,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",28054.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8815.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8344.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8728.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29613.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",26496.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18703.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8513.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8344.74,29613.4,
"INFINITY TRAY TIBIAL BIOFOAM SIZE 4",690355,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,31172,,,20885.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8344.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15586,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",28054.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8815.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8344.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8728.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29613.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",26496.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8728.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18703.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8513.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8344.74,29613.4,
"INTEGRA BIOFIX FLOW 1CC",664003,CDM,278,RC,C9399,HCPCS,"OUTPATIENT ",,,19140,,,12823.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5359.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5123.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5359.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9570,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",17226,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5412.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5123.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5359.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",18183,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",16269,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5359.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11484,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5227.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5123.78,18183,
"Interfyl Tissue Matrix, 1 mL Flowable",690849,CDM,636,RC,Q4171,HCPCS,"OUTPATIENT ",,,12100,,,8107,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3388,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3239.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3388,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6050,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10890,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3421.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3239.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3388,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11495,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10285,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3388,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7260,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3304.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3239.17,11495,
"Ion 5.5 x 10mm Facet Screw Bundle",690848,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,16800,,,11256,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4497.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15120,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4751.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4497.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4704,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15960,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14280,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10080,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4588.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4497.36,15960,
"Ion Bundle",690691,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,34000,,,22780,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9520,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9101.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9520,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",30600,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9615.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9101.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9520,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",32300,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",28900,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9520,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20400,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9285.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9101.8,32300,
"Ion Facet Screw Bundle 6.0 x 10mm & Decortication Rasp (Circular)",690794,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,16800,,,11256,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4497.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15120,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4751.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4497.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4704,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15960,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14280,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10080,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4588.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4497.36,15960,
"Ion Facet Screw Bundle 6.5 x 10mm & Decortication Rasp (Circular)",690784,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,16800,,,11256,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4497.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15120,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4751.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4497.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4704,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15960,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14280,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4704,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10080,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4588.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4497.36,15960,
"Journey 7.5mm Resurfacing Patellar Component",691191,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"JOURNEY ARTICULAR INSERT",664171,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4000,,,2680,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1070.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3600,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1131.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1070.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1120,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3800,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3400,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2400,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1092.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1070.8,3800,
"JOURNEY ARTICULAR INSERT RIGHT SIZE 3-4",690272,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"JOURNEY ARTICULAR INSERT RIGHT SIZE 5-6",690251,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"JOURNEY ARTICULAR INSERT RIGHT SIZE 5-6 9MM",690308,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"JOURNEY BCS STANDARD RESURFACING ROUND PATELLAR COMPONENT 38MM",690928,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"JOURNEY II ARTICULAR INSERT",690224,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"JOURNEY II ARTICULAR INSERT LEFT, SIZE 3-4 10MM",691056,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"Journey II Articular Insert Right 10mm Size 5-6",691226,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6000,,,4020,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1606.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1696.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1606.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1680,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5700,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5100,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1680,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1638.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1606.2,5700,
"Journey II Articular Insert Right, 13mm, Size 7-8",691515,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"Journey II Articular Insert Right, 9mm, Size 7-8",691190,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"JOURNEY II OXINIUM FEMORAL COMPONENT SIZE 5",690760,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,8400,,,5628,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2352,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2248.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2352,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7560,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2375.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2248.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2352,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7980,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7140,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2352,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5040,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2294.04,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2248.68,7980,
"JOURNEY II OXINIUM FEMORAL COMPONENT SIZE 5 right med/ left lateral",691076,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,11200,,,7504,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3136,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2998.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3136,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10080,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3167.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2998.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3136,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10640,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9520,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3136,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6720,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3058.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2998.24,10640,
"JOURNEY II OXINIUM FEMORAL COMPONENT SIZE 8 LEFT",690815,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12800,,,8576,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3426.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11520,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3619.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3426.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3584,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12160,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10880,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7680,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3495.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3426.56,12160,
"JOURNEY II TIBIAL BASEPLATE SIZE 7, LEFT MEDIAL",690967,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"JOURNEY II UK MEDIAL TIBIA INSERT SIZE 5-6, 9 MM XLPE",690719,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,8000,,,5360,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2141.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2262.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2141.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2240,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7600,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6800,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2184.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2141.6,7600,
"JOURNEY II UNI MEDIAL TIBIA INSERT SIZE 3-4, 8 MM",691274,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"JOURNEY II UNI MEDIAL TIBIA INSERT SIZE 5-6, 8 MM",690268,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,8000,,,5360,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2141.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2262.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2141.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2240,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7600,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6800,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2184.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2141.6,7600,
"JOURNEY II UNI MEDIAL TIBIA INSERT SIZE 7-8, 10MM",690368,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9600,,,6432,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2569.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8640,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2714.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2569.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2688,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9120,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8160,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5760,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2621.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2569.92,9120,
"JOURNEY II UNI MEDIAL TIBIA INSERT SIZE 7-8, 11MM",690966,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"JOURNEY II UNI MEDIAL TIBIA INSERT SIZE 9-10, 8MM",690684,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"JOURNEY II UNI OX FEMORAL COMPONENT SIZE 4",690267,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12800,,,8576,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3426.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11520,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3619.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3426.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3584,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12160,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10880,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7680,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3495.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3426.56,12160,
"JOURNEY II UNI OXINIUM FEMORAL COMPONENT SIZE 3",690720,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,8533.32,,,5717.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2389.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2284.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2389.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4266.66,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7679.99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2413.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2284.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2389.33,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8106.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7253.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2389.33,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5119.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2330.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2284.37,8106.65,
"JOURNEY II UNI OXINIUM FEMORAL COMPONENT SIZE 6",690359,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9600,,,6432,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2569.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8640,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2714.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2569.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2688,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9120,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8160,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5760,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2621.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2569.92,9120,
"JOURNEY II UNI OXINIUM FEMORAL COMPONENT SIZE 8",690683,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12800,,,8576,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3426.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11520,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3619.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3426.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3584,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12160,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10880,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7680,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3495.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3426.56,12160,
"Journey II Uni Right Size 9 Medial Tibia Baseplate",691174,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9600,,,6432,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2569.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8640,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2714.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2569.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2688,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9120,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8160,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5760,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2621.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2569.92,9120,
"JOURNEY II UNI SIZE 10, RIGHT MEDIAL TIBIA BASEPLATE",690682,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"JOURNEY II UNI Size 5-6, 10mm, MEDIAL TIBIA INSERT",691077,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"JOURNEY II UNI SIZE 7, RIGHT MEDIAL TIBIA BASEPLATE",690358,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"Journey II Uni Size 9-10, 11mm Tibia Insert Medial XLPE",691175,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"JOURNEY II UNI TIBIAL BASEPLATE SIZE 4 RIGHT MEDIAL",691273,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"JOURNEY II UNI TIBIAL BASEPLATE SIZE 5 RIGHT MEDIAL",690269,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"JOURNEY II UNI TIBIAL BASEPLATE SIZE 6, LEFT MEDIAL",690759,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9200,,,6164,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2576,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2462.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2576,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8280,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2601.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2462.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2576,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8740,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7820,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2576,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5520,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2512.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2462.84,8740,
"JOURNEY II UNI TIBIAL BASEPLATE SIZE 9, LEFT MEDIAL",690816,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"Journey Non Porous Tibial Baseplate Size 3 Left",690223,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"Journey Non Porous Tibial Baseplate Size 5 Left",691276,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"JOURNEY NONPOROUS TIBIAL BASEPLATE LEFT SIZE 7",690375,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"JOURNEY NONPOROUS TIBIAL BASEPLATE SIZE 4 RIGHT",690271,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"JOURNEY NONPOROUS TIBIAL BASEPLATE SIZE 5 RIGHT",690250,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"JOURNEY NONPOROUS TIBIAL BASEPLATE SIZE 6  RIGHT",690310,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"JOURNEY NONPOROUS TIBIAL BASEPLATE SIZE 6 LEFT",690927,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"JOURNEY RESURFACING PATELLAR COMPONENT 32MM",690969,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"JOURNEY RESURFACING ROUND PATELLAR COMPONENT",690222,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2361.6,,,1582.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",661.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",632.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",661.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1180.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2125.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",667.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",632.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",661.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2243.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2007.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",661.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1416.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",644.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",632.2,2243.52,
"JOURNEY RESURFACING ROUND PATELLAR COMPONENT 32MM",664170,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"Journey Resurfacing Round Patellar Component 35mm",690252,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"Journey Size 3, Left Oxinium Bi-Cruciate Nonporous Femoral Component",690221,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"K2M CASCADIA CERVICAL CAGE",663723,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5600,,,3752,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1499.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5040,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1583.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1499.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1568,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5320,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4760,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3360,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1529.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1499.12,5320,
"K2M DBM PUTTY 100 1.0 CC",663724,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1466.36,,,982.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",410.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",392.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",410.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",733.18,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1319.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",414.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",392.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",410.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1393.04,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1246.41,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",410.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",879.82,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",400.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",392.54,1393.04,
"K2M DBM PUTTY 100 10 CC",663814,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6160,,,4127.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1724.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1649.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1724.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3080,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5544,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1742.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1649.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1724.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5852,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5236,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1724.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3696,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1682.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1649.03,5852,
"Komet Screw Guide 3.20 mm 50mm 6-Kant Heaxagonal",690360,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,796,,,533.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",213.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",796,100,,,,,0,"fee schedule","100% of total billed charges",716.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",225.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",213.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",222.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",756.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",676.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",222.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",477.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",217.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",213.09,796,
"L4631Afo, walk boot type, cus fab TechFee",246310,CDM,450,RC,L4631,HCPCS,"OUTPATIENT ",,,2084.66,,,1396.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",583.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",558.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",583.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1876.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",589.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",558.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",583.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1980.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1771.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",583.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1250.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",569.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",558.06,1980.43,
"Lapiplasty Plantar Power Plate",664491,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7000,,,4690,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1960,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1873.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1960,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6300,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1979.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1873.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1960,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6650,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5950,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1960,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1911.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1873.9,6650,
"LEGION HIGH FLEXION ARTICULAR INSERT",690228,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"LEGION OFFSET COUPLER 4MM",690798,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14100,,,9447,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3948,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3774.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3948,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7050,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12690,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3987.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3774.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3948,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13395,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11985,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3948,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8460,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3850.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3774.57,13395,
"Legion Offset Coupler 6mm",691339,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14100,,,9447,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3948,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3774.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3948,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7050,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12690,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3987.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3774.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3948,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13395,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11985,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3948,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8460,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3850.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3774.57,13395,
"LEGION OFFSET COUPLER WITH SCREW 4MM",690903,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9400,,,6298,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2632,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2516.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2632,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8460,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2658.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2516.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2632,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8930,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7990,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2632,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2567.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2516.38,8930,
"LEGION OXINIUM CONSTRAINED FEMORAL COMPONENT",690225,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,61193,,,40999.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17134.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16381.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17134.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30596.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",55073.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17305.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16381.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17134.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58133.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",52014.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17134.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36715.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16711.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16381.37,58133.35,
"LEGION OXINIUM CONSTRAINED FEMORAL COMPONENT, SIZE 5, LEFT",690904,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,48960,,,32803.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13708.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13106.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13708.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",24480,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",44064,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13845.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",13106.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",13708.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",46512,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",41616,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13708.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",29376,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",13370.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",13106.59,46512,
"Legion Oxinium Constrained Nonporous Femoral Component Size 6, Left",691340,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,61193,,,40999.31,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17134.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16381.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17134.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",30596.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",55073.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17305.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16381.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17134.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",58133.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",52014.05,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17134.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",36715.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",16711.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16381.37,58133.35,
"LEGION PRESSFIT STEM",690227,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,11341,,,7598.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3035.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5670.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10206.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3207.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3035.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3175.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10773.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9639.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6804.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3097.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3035.99,10773.95,
"LEGION PRESSFIT STEM STRAIGHT 11mm X 160mm",690799,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9416,,,6308.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2636.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2520.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2636.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4708,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8474.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2662.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2520.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2636.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8945.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8003.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2636.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5649.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2571.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2520.66,8945.2,
"LEGION PRESSFIT STEM STRAIGHT 13mm X 160mm",690796,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9416,,,6308.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2636.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2520.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2636.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4708,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8474.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2662.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2520.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2636.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8945.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8003.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2636.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5649.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2571.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2520.66,8945.2,
"LEGION REVISION TIBIAL BASEPLATE size 4, Right",690797,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,26700,,,17889,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7147.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13350,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",24030,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7550.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7147.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7476,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25365,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22695,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7476,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16020,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7291.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7147.59,25365,
"Legion Revision Tibial Baseplate, Size 6 Left",691337,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,29380,,,19684.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8226.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7865.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8226.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14690,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",26442,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8308.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7865.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8226.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27911,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",24973,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8226.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17628,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8023.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7865.03,27911,
"Legion Straight Cemented Stem 12mm x 120mm",691338,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,27140,,,18183.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7599.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7265.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7599.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13570,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",24426,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7675.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7265.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7599.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25783,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23069,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7599.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16284,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7411.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7265.38,25783,
"LEGION TIBIAL CONE 22 I.D.",690800,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,37080,,,24843.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10382.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9926.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10382.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18540,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",33372,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10486.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9926.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10382.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35226,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",31518,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10382.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22248,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10126.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9926.32,35226,
"LENS CLAREON PRELOAD CCA0T0",690099,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,596,,,399.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",159.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",536.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",159.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",166.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",566.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",506.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",166.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",357.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",162.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",159.55,566.2,
"LENS SINGLE ACRYSOFT IOL",664479,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,436,,,292.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",116.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",392.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",116.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",122.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",414.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",370.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",122.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",261.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",119.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",116.72,414.2,
"LENS TECNIS EYHANCE IOL PRELOAD",664674,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,620,,,415.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",558,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",173.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",589,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",527,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",372,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",169.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.97,589,
"LENS TECNIS EYHANCE TORIC II DIU150",690096,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"LENS TECNIS EYHANCE TORIC II DIU300",690097,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,2380,,,1594.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",637.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2142,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",673.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",637.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",666.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2261,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2023,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",666.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1428,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",649.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",637.13,2261,
"LENS TECNIS MONOFOCAL ZCB00",690098,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,628,,,420.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",168.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",565.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",168.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",175.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",596.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",533.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",376.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",171.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",168.12,596.6,
"LENS TRIFOCAL ACRYSOFT IQ PANOPTIX",664430,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,3980,,,2666.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1065.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3582,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1125.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1065.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1114.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3781,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3383,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2388,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1086.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1065.45,3781,
"LENS TRIFOCAL ACRYSOFT IQ PANOPTIX TORIC",664468,CDM,278,RC,V2632,HCPCS,"OUTPATIENT ",,,3980,,,2666.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1065.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1990,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3582,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1125.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1065.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1114.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3781,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3383,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2388,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1086.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1065.45,3781,
"LOOP RECORDER LUX-Dx",664444,CDM,278,RC,C1764,HCPCS,"OUTPATIENT ",,,13500,,,9045,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3780,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3613.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3780,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12150,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3817.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3613.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3780,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12825,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11475,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3780,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8100,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3686.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3613.95,12825,
"LOOP RECORDER LUX-Dx II+",690780,CDM,278,RC,C1764,HCPCS,"OUTPATIENT ",,,18000,,,12060,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4818.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5090.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4818.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5040,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17100,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15300,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5040,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4915.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4818.6,17100,
"Lordosis Cervical Spacer 8x11x14 mm",690604,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MA60AC Lens",691663,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,496,,,332.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",138.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",132.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",138.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",446.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",140.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",132.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",138.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",471.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",421.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",138.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",297.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",135.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",132.78,471.2,
"MatrixCellect? 100 DBM Putty, 10cc Syringe",691602,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,4600,,,3082,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1288,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1231.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1288,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4140,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1300.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1231.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1288,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4370,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3910,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1288,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2760,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1256.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1231.42,4370,
"MatrixCellect? 100 DBM Putty, 2.5cc Syringe",690754,CDM,272,RC,C9359,HCPCS,"OUTPATIENT ",,,1400,,,938,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",392,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",374.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",392,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1260,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",395.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",374.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",392,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1330,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1190,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",392,28,,,,,0,"percent of total billed charges ","28% of total billed charges",840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",382.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",374.78,1330,
"Medartis  2/8 hole Locking Plate",691052,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5264,,,3526.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1473.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1409.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1473.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2632,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4737.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1488.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1409.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1473.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5000.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4474.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1473.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3158.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1437.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1409.17,5000.8,
"Medartis 0? MTP Fusion Plate, right",691035,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12832,,,8597.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3592.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3435.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3592.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6416,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11548.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3628.89,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3435.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3592.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12190.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10907.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3592.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7699.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3504.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3435.13,12190.4,
"Medartis 1.2mm x 6mm Cortical Screw",691369,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 1.2mm x 7mm Cortical Screw",691368,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 1.5mm x 08mm Locking Screw",663769,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 1.5mm x 10mm Locking Screw",691080,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 1.5mm x 11mm Cortex Screw",691048,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 1.5mm x 11mm Locking Screw",691250,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 1.5mm x 12mm Locking Screw",691251,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 1.5mm x 13mm Locking Screw",691252,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 1.5mm x 5mm Comp Screw",691480,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 1.5mm x 7mm Cortex Screw",663583,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 1.5mm x 8mm Cortex Screw",690186,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 1.5mm x 9mm Cortex Screw",690184,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"MEDARTIS 10mm x 2.0 TriLock Screw",690635,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"MEDARTIS 12mm x 2.0 Cortical Screw",690631,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,617.6,,,413.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",617.6,100,,,,,0,"fee schedule","100% of total billed charges",555.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",586.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.33,617.6,
"MEDARTIS 12mm x 2.0 TriLock Screw",690633,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"MEDARTIS 13mm x 2.0 TriLock Screw",690634,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"MEDARTIS 2.0 / 2.3 TriLock Four Corner Fusion Plates, Dorsal",663561,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9352,,,6265.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2618.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2503.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2618.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4676,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8416.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2644.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2503.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2618.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8884.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7949.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2618.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5611.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2554.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2503.53,8884.4,
"MEDARTIS 2.0/2.3 Countersink for Cortical Screw",690747,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,927,,,621.09,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",259.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",259.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",927,100,,,,,0,"fee schedule","100% of total billed charges",834.3,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",262.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",248.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",259.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",880.65,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",787.95,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",259.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",556.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",253.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",248.16,927,
"Medartis 2.0mm x 10mm Cortex Screw",690274,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 2.0mm x 11mm Locking Screw",691050,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 2.0mm x 16mm Cortex Screw",691471,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 2.0mm x 16mm Locking Screw",691051,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 2.0mm x 18mm Cortex Screw",691049,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 2.0mm X 18mm Locking Screw",691262,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 2.2 x 22mm Headless Comp Screw",691455,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1680,,,1125.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",449.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",840,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1512,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",475.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",449.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",470.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1596,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1428,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1008,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",458.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",449.74,1596,
"Medartis 2.2 x 28mm Headless Comp Screw",691454,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1680,,,1125.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",449.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",840,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1512,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",475.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",449.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",470.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1596,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1428,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1008,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",458.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",449.74,1596,
"Medartis 2.2mm x 13mm headless screw",690769,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2128.8,,,1426.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",596.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",569.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",596.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1064.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1915.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",602.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",569.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",596.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2022.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1809.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",596.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1277.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",581.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",569.88,2022.36,
"Medartis 2.2mm x 16mm headless screw",690768,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2128.8,,,1426.3,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",596.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",569.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",596.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1064.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1915.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",602.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",569.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",596.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2022.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1809.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",596.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1277.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",581.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",569.88,2022.36,
"Medartis 2.5 TriLock Ulna Shortening Plate",690912,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7276.4,,,4875.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2037.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1947.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2037.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3638.2,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6548.76,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2057.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1947.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2037.39,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6912.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6184.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2037.39,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4365.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1987.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1947.89,6912.58,
"Medartis 2.5 x 20mm Cortical Screw",691004,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 2.5 x12mm Cortical Screw",664007,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 2.5 x14mm Cortical Screw",691003,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 2.5 x16mm Cortical Screw",690917,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 2.5 x18mm Cortical Screw",690918,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis 2.8mm x 12mm TriLock Screw",691037,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 2.8mm x 14mm TriLock Screw",691038,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 2.8mm x 18mm TriLock Screw",691039,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 2.8mm x 20mm TriLock Screw",691040,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 2.8mm x 22mm TriLock Screw",691041,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 2.8mm x 24mm TriLock Screw",691042,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis 3 x 3 Hole Locking Plate",691478,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3612,,,2420.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1011.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",966.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1011.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1806,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3250.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1021.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",966.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1011.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3431.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3070.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1011.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2167.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",986.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",966.93,3431.4,
"Medartis 3.0mm x 18mm Headless Compression Screw",691044,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1680.32,,,1125.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",470.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",449.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",470.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",840.16,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1512.29,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",475.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",449.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",470.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1596.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1428.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",470.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1008.19,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",458.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",449.82,1596.3,
"Medartis 3.0mm x 22mm Headless Screw",691043,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1680,,,1125.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",449.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",840,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1512,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",475.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",449.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",470.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1596,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1428,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1008,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",458.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",449.74,1596,
"Medartis 3.0mm x 23mm Headless Screw",691156,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1680,,,1125.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",449.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",840,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1512,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",475.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",449.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",470.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1596,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1428,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1008,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",458.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",449.74,1596,
"Medartis 3.0mm x 25mm Headless Screw",691045,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1680,,,1125.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",449.74,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",840,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1512,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",475.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",449.74,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",470.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1596,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1428,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",470.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1008,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",458.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",449.74,1596,
"Medartis 4.0 x 24mm Headless Comp Screw",691451,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2004,,,1342.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1002,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1803.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",566.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",536.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",561.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1903.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1703.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1202.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",547.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.47,1903.8,
"Medartis 4.0 x 28mm Headless Comp Screw",691452,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2004,,,1342.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1002,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1803.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",566.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",536.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",561.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1903.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1703.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1202.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",547.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.47,1903.8,
"Medartis 4.0 x 34mm Headless Comp Screw",691449,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2004,,,1342.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1002,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1803.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",566.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",536.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",561.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1903.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1703.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1202.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",547.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.47,1903.8,
"Medartis 4.0 x 40mm Headless Comp Screw",691450,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2004,,,1342.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1002,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1803.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",566.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",536.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",561.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1903.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1703.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",561.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1202.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",547.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",536.47,1903.8,
"Medartis 5 Hole Left Condyle Plate",691479,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3880,,,2599.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1086.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1038.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1086.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1940,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3492,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1097.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1038.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1086.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3686,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3298,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1086.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2328,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1059.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1038.68,3686,
"Medartis 5.0 CCS Countersink",691054,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1340,,,897.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",375.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",358.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",375.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",670,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1206,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",378.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",358.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",375.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1273,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1139,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",375.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",804,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",365.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",358.72,1273,
"Medartis 5.0 x 40mm Headless Screw",691055,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2760,,,1849.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",772.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",738.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",772.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1380,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2484,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",780.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",738.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",772.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2622,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2346,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",772.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1656,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",753.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",738.85,2622,
"Medartis 5.0 x 45mm Headless Screw",691266,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2760,,,1849.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",772.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",738.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",772.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1380,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2484,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",780.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",738.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",772.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2622,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2346,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",772.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1656,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",753.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",738.85,2622,
"Medartis 5.0 x 50mm Headless Screw",690742,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2612,,,1750.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",731.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",699.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",731.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1306,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2350.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",738.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",699.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",731.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2481.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2220.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",731.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1567.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",713.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",699.23,2481.4,
"MEDARTIS 6 HOLE PLATE 1.0 MM",690273,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2952.8,,,1978.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",826.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",790.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",826.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1476.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2657.52,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",835.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",790.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",826.78,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2805.16,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2509.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",826.78,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1771.68,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",806.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",790.46,2805.16,
"MEDARTIS 8mm x 2.0 TriLock Screw",690632,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1011.2,,,677.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",283.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",270.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",283.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",505.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",910.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",285.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",270.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",283.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",960.64,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",859.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",283.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",606.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",276.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",270.7,960.64,
"MEDARTIS CANULATER SCREW 3.0 X 22MM",690140,CDM,278,RC,c1713,HCPCS,"OUTPATIENT ",,,1669.2,,,1118.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",467.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",446.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",467.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",834.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1502.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",472.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",446.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",467.38,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1585.74,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1418.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",467.38,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1001.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",455.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",446.84,1585.74,
"MEDARTIS CORTICAL SCREW 1.2 X 10MM",690695,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,617.6,,,413.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",617.6,100,,,,,0,"fee schedule","100% of total billed charges",555.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",586.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.33,617.6,
"MEDARTIS CORTICAL SCREW 1.5 X 10MM",690185,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"MEDARTIS CORTICAL SCREW 2.0 X 11 MM",690276,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,617.6,,,413.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",617.6,100,,,,,0,"fee schedule","100% of total billed charges",555.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",586.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.33,617.6,
"MEDARTIS CORTICAL SCREW 2.0 X 13 MM",690277,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"MEDARTIS CORTICAL SCREW 2.0 X 6 MM",690278,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,617.6,,,413.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",617.6,100,,,,,0,"fee schedule","100% of total billed charges",555.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",586.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.33,617.6,
"MEDARTIS CORTICAL SCREW 2.0 X 7 MM",690279,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,617.6,,,413.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.33,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",617.6,100,,,,,0,"fee schedule","100% of total billed charges",555.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.33,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",172.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",586.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",524.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",172.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",370.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",168.67,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.33,617.6,
"MEDARTIS CORTICAL SCREW 2.0 X 8 MM",690275,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"MEDARTIS CORTICAL SCREW 2.0 X 9MM",664380,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,696,,,466.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",186.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",696,100,,,,,0,"fee schedule","100% of total billed charges",626.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",186.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",194.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",661.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",591.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",194.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",417.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",190.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",186.32,696,
"Medartis Dorsal Distal Radius Plate",690748,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5204,,,3486.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1457.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1393.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1457.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2602,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4683.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1471.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1393.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1457.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4943.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4423.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1457.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3122.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1421.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1393.11,4943.8,
"Medartis Keriflex MCP 20 Finger Joint Prosthesis",691092,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9652,,,6466.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2702.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2583.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2702.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4826,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8686.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2729.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2583.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2702.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9169.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8204.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2702.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5791.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2635.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2583.84,9169.4,
"MEDARTIS LOCKING SCREW 2.0 X 7MM",663512,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1011.2,,,677.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",283.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",270.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",283.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",505.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",910.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",285.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",270.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",283.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",960.64,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",859.52,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",283.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",606.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",276.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",270.7,960.64,
"MEDARTIS PLATE 3-5 HOLE",690187,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1908.4,,,1278.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",534.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",510.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",534.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",954.2,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1717.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",539.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",510.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",534.35,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1812.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1622.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",534.35,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1145.04,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",521.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",510.88,1812.98,
"MEDARTIS PLATE 4 HOLE STR",663470,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1570.8,,,1052.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",439.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",439.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",785.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1413.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",444.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",420.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",439.82,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1492.26,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1335.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",439.82,28,,,,,0,"percent of total billed charges ","28% of total billed charges",942.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",428.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",420.5,1492.26,
"MEDARTIS PLATE RSL FUSION",664006,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5869.6,,,3932.63,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1643.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1571.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1643.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2934.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5282.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1659.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1571.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1643.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5576.12,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4989.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1643.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3521.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1602.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1571.29,5576.12,
"MEDARTIS SCREW 2.0 CORTICAL",663471,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,407.4,,,272.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",114.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",114.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",407.4,100,,,,,0,"fee schedule","100% of total billed charges",366.66,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",109.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",114.07,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",387.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",346.29,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",114.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges",244.44,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",111.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",109.06,407.4,
"MEDARTIS SCREW CANN 2.2/3.0",663536,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1755.6,,,1176.25,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",491.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",469.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",491.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",877.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1580.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",496.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",469.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",491.57,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1667.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1492.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",491.57,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1053.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",479.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",469.97,1667.82,
"MEDARTIS SCREW HEADLESS 3.0 X 16MM",690054,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1935.2,,,1296.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",541.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",518.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",541.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",967.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1741.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",547.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",518.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",541.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1838.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",541.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1161.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",528.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",518.05,1838.44,
"MEDARTIS SCREW HEADLESS 3.0 X 21MM",690053,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1935.2,,,1296.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",541.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",518.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",541.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",967.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1741.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",547.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",518.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",541.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1838.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1644.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",541.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1161.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",528.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",518.05,1838.44,
"Medartis TriLock 8 Hole Straight Plate",691079,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3528,,,2363.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",987.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",944.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",987.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1764,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3175.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",997.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",944.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",987.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3351.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2998.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",987.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2116.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",963.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",944.45,3351.6,
"Medartis Trilock Screw 2.5 x 12mm",664008,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,727.2,,,487.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",203.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",194.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",203.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",727.2,100,,,,,0,"fee schedule","100% of total billed charges",654.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",205.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",194.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",203.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",690.84,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",618.12,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",203.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",436.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",198.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",194.67,727.2,
"Medartis Trilock Screw 2.5 x 14mm",690919,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis Trilock Screw 2.5 x 16mm",690920,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"Medartis Trilock Screw 2.5 x 18mm",691119,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"MEDARTIS Y PLATE 7 HOLE",664378,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3304,,,2213.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",925.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",884.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",925.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1652,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2973.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",934.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",884.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",925.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3138.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2808.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",925.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1982.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",902.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",884.48,3138.8,
"MESH 3D MAX LARGE",663799,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,911.6,,,610.77,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",255.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",244.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",255.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",911.6,100,,,,,0,"fee schedule","100% of total billed charges",820.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",257.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",244.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",255.25,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",866.02,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",774.86,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",255.25,28,,,,,0,"percent of total billed charges ","28% of total billed charges",546.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",248.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",244.04,911.6,
"MESH 3DMAX MID LEFT LARGE 4 X 6 IN",664452,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,979.2,,,656.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",979.2,100,,,,,0,"fee schedule","100% of total billed charges",881.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",276.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",930.24,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",832.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",587.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.13,979.2,
"MESH 3DMAX MID LEFT MEDIUM 3 X 5 IN",664451,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,839.6,,,562.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",235.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",235.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",839.6,100,,,,,0,"fee schedule","100% of total billed charges",755.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",237.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",224.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",235.09,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",797.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",713.66,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",235.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges",503.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",224.76,839.6,
"MESH 3DMAX MID RIGHT LARGE 4 X 6 IN",664455,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,979.2,,,656.06,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",274.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",262.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",274.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",979.2,100,,,,,0,"fee schedule","100% of total billed charges",881.28,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",276.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",262.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",274.18,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",930.24,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",832.32,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",274.18,28,,,,,0,"percent of total billed charges ","28% of total billed charges",587.52,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",267.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",262.13,979.2,
"MESH 3DMAX MID RIGHT MEDIUM 3 X 5 IN",664454,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,920.36,,,616.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",257.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",246.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",257.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",920.36,100,,,,,0,"fee schedule","100% of total billed charges",828.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",260.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",246.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",257.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",874.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",782.31,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",257.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",552.22,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",251.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",246.38,920.36,
"Mesh 7.6 x 15cm",664492,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,434.4,,,291.05,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",121.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",116.29,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",121.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",434.4,100,,,,,0,"fee schedule","100% of total billed charges",390.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",122.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",116.29,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",121.63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",412.68,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",369.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",121.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",260.64,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",118.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",116.29,434.4,
"MESH PELVIC FLOOR GPSL",663048,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,780,,,522.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",218.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",208.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",218.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",780,100,,,,,0,"fee schedule","100% of total billed charges",702,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",220.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",208.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",218.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",741,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",663,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",218.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",468,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",213.02,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",208.81,780,
"MESH PHASIX 11CM CIRCLE",664011,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,7660,,,5132.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2144.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2050.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2144.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3830,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6894,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2166.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2050.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2144.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7277,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6511,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2144.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4596,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2091.95,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2050.58,7277,
"MESH PHASIX 4  X 4",663957,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,8500,,,5695,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2380,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2275.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2380,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7650,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2403.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2275.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2380,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8075,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7225,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2380,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5100,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2321.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2275.45,8075,
"MESH PHASIX ST 11CM CIRCLE",664021,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,8120,,,5440.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2273.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2173.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2273.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4060,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7308,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2296.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2173.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2273.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7714,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6902,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2273.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4872,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2217.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2173.72,7714,
"MESH PHASIX ST 20 X 25CM",664022,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,34694,,,23244.98,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",9714.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9287.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",9714.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17347,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",31224.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",9811.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9287.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",9714.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",32959.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",29489.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",9714.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",20816.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9474.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9287.58,32959.3,
"MESH PHASIX ST 5  X 10",663958,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,28240,,,18920.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7559.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",25416,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7986.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7559.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7907.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",26828,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",24004,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16944,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7712.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7559.85,26828,
"MESH PHASIX ST 6  X 8",664004,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,26060,,,17460.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6976.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13030,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",23454,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7369.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6976.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7296.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24757,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22151,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15636,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7116.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6976.26,24757,
"MESH PHASIX ST 7 X 10cm",663995,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,5935.6,,,3976.85,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1661.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1588.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1661.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2967.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5342.04,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1678.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1588.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1661.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5638.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5045.26,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1661.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3561.36,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1621.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1588.96,5638.82,
"MESH PRESHAPED 4.5 X 10CM",664020,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,209.6,,,140.43,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",58.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",56.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",58.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",209.6,100,,,,,0,"fee schedule","100% of total billed charges",188.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",56.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",58.69,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",199.12,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",178.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",58.69,28,,,,,0,"percent of total billed charges ","28% of total billed charges",125.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",57.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",56.11,209.6,
"MESH PROLENE PMII",662648,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,145.12,,,97.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",40.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",38.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",40.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",145.12,100,,,,,0,"fee schedule","100% of total billed charges",130.61,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",38.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",40.63,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",137.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",123.35,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",40.63,28,,,,,0,"percent of total billed charges ","28% of total billed charges",87.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",39.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",38.85,145.12,
"MESH VENTRALIGHT ST W/ECHO 2 11CM",663959,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,2468.8,,,1654.1,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",691.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",660.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",691.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1234.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2221.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",698.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",660.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",691.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2345.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2098.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",691.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1481.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",674.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",660.9,2345.36,
"MESH VENTRALIGHT ST W/ECHO 2 15CM",663973,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,3481.6,,,2332.67,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",974.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",932.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",974.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1740.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3133.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",984.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",932.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",974.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3307.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2959.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",974.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2088.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",950.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",932.02,3307.52,
"MESH VENTRALIGHT W/ ECHO 10 X 15CM",664016,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,2257.6,,,1512.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",632.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",604.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",632.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1128.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2031.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",638.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",604.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",632.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2144.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1918.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",632.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1354.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",616.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",604.36,2144.72,
"MESH VENTRIO ST 11 X 14CM",664018,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,3392,,,2272.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",949.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",908.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",949.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3052.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",959.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",908.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",949.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3222.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2883.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",949.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2035.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",926.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",908.04,3222.4,
"MESH VENTRIO ST 13.8 X 17.8 CM",664019,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,4297.2,,,2879.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1203.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1150.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1203.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2148.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3867.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1215.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1150.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1203.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4082.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3652.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1203.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2578.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1173.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1150.36,4082.34,
"MESH VENTRIO ST 8 X 12CM",664017,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,2300.4,,,1541.27,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",644.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",615.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",644.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1150.2,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2070.36,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",650.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",615.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",644.11,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2185.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1955.34,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",644.11,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1380.24,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",628.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",615.82,2185.38,
"MESH VENTRIO ST PATCH 19.6 X 24.6CM",664057,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,6016.4,,,4030.99,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1684.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1610.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1684.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3008.2,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5414.76,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1701.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1610.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1684.59,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5715.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5113.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1684.59,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3609.84,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1643.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1610.59,5715.58,
"MESH VENTRIO ST PATCH 22.1 X 27.1",664078,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,7095.2,,,4753.78,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1986.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1899.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1986.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3547.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6385.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2006.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1899.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1986.66,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6740.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6030.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1986.66,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4257.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1937.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1899.39,6740.44,
"MESH Y UPSYLON",663044,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,4158,,,2785.86,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1164.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1113.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1164.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2079,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3742.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1175.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1113.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1164.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3950.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3534.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1164.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2494.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1135.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1113.1,3950.1,
"Micro Corkscrew Suture Anchor ft with 4-0 Fiberwire",691461,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1331.52,,,892.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",372.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",356.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",372.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",665.76,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1198.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",376.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",356.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",372.83,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1264.94,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1131.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",372.83,28,,,,,0,"percent of total billed charges ","28% of total billed charges",798.91,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",363.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",356.45,1264.94,
"MIMEDX AMNIOTIC MEMBRANE 4 X 4",663028,CDM,278,RC,Q4100,HCPCS,"OUTPATIENT ",,,7124,,,4773.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1994.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1907.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1994.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3562,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6411.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2014.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1907.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1994.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6767.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6055.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1994.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4274.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1945.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1907.09,6767.8,
"MINISTIM PNS  pIPG receiver KIT",691541,CDM,278,RC,C9807,HCPCS,"OUTPATIENT ",,,47200,,,31624,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",13216,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12635.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",13216,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",23600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",42480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13348.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12635.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",13216,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",44840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",40120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",13216,28,,,,,0,"percent of total billed charges ","28% of total billed charges",28320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12890.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12635.44,44840,
"MIRUS 12mm x 4.25mm Variable Self-Tapping Screw",690338,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"MIRUS 14mm x 4.25mm Variable Self-Tapping Screw",690369,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"MIRUS 16mm x 3.75mm Variable Self-Drilling Screw",690337,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"Mirus 2.7 x 22 Nonlocking Screw",691488,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,460,,,308.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",460,100,,,,,0,"fee schedule","100% of total billed charges",414,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.14,460,
"Mirus 27 x 20mm Nonlocking Screw",691497,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,460,,,308.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",460,100,,,,,0,"fee schedule","100% of total billed charges",414,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.14,460,
"Mirus 3.5 x 12 Locking Screw",691491,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,460,,,308.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",460,100,,,,,0,"fee schedule","100% of total billed charges",414,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.14,460,
"Mirus 3.5 x 14 Locking Screw",691490,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,588,,,393.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",164.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",157.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",164.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",588,100,,,,,0,"fee schedule","100% of total billed charges",529.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",166.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",157.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",164.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",558.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",499.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",164.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",352.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",160.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",157.41,588,
"Mirus 3.5 x 16 Locking Screw",691489,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,588,,,393.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",164.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",157.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",164.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",588,100,,,,,0,"fee schedule","100% of total billed charges",529.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",166.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",157.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",164.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",558.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",499.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",164.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",352.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",160.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",157.41,588,
"Mirus 3.5 x 20 Nonlocking Screw",691492,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,460,,,308.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",123.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",460,100,,,,,0,"fee schedule","100% of total billed charges",414,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",123.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",128.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",437,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",391,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",128.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",276,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",125.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",123.14,460,
"MIRUS 32mm Anterior Cervical Plate - MoTi Level 2",690332,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7300,,,4891,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1954.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2064.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1954.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2044,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6935,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6205,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1993.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1954.21,6935,
"Mirus 4.0 x 48 Cannulated Screw",691538,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1140,,,763.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",319.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",305.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",319.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",570,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1026,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",322.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",305.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",319.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1083,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",969,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",319.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",684,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",311.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",305.18,1083,
"Mirus 8mm Anterior Cervical Plate - MoTi Level 1",691414,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6502,,,4356.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1820.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1740.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1820.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3251,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5851.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1838.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1740.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1820.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6176.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5526.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1820.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3901.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1775.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1740.59,6176.9,
"Mirus Anatomic Distal Fibula Plate 5 Hole, Right MoRe",691493,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8800,,,5896,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2464,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2355.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2464,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7920,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2488.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2355.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2464,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8360,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7480,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2464,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5280,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2403.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2355.76,8360,
"MIRUS CERVICAL CAGE",664052,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS CERVICAL PLATE 2 LEVEL",664027,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5200,,,3484,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1456,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1392.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1456,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4680,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1470.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1392.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1456,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4940,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4420,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1456,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3120,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1420.12,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1392.04,4940,
"MIRUS CERVICAL PLATE MULTI LEVEL",664118,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7300,,,4891,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1954.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2064.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1954.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2044,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6935,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6205,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1993.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1954.21,6935,
"MIRUS CORTICAL CERVICAL SPACER PARALLEL",690051,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS CYGNUS 16mm x 4.25mm Variable Self-Tapping Screw",690536,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"MIRUS PLATE ANTERIOR CERVICAL 12MM",690086,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6500,,,4355,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1740.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5850,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1838.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1740.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1820,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6175,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5525,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3900,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1775.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1740.05,6175,
"MIRUS PLATE ANTERIOR CERVICAL 14mm",691306,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6500,,,4355,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1740.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5850,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1838.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1740.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1820,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6175,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5525,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1820,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3900,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1775.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1740.05,6175,
"MIRUS PLATE ANTERIOR CERVICAL 24MM",690084,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7300,,,4891,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1954.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2064.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1954.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2044,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6935,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6205,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1993.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1954.21,6935,
"MIRUS PLATE ANTERIOR CERVICAL 26MM",690117,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7300,,,4891,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1954.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3650,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2064.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1954.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2044,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6935,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6205,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1993.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1954.21,6935,
"MIRUS PLATE ANTERIOR CERVICAL 28MM",690270,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,7300,,,4891,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1954.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",6570,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2064.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1954.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2044,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6935,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6205,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2044,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4380,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1993.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1954.21,6935,
"MIRUS PLATE ANTERIOR CERVICAL 8MM",690109,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4062.5,,,2721.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1137.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1087.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1137.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2031.25,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3656.25,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1148.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1087.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1137.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3859.38,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3453.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1137.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2437.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1109.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1087.53,3859.38,
"MIRUS RIGEL 3DR CERVICAL INTERBODY 14 X 12 X 5MM",690636,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS RIGEL 3DR CERVICAL INTERBODY 14 X 12 X 6MM",690081,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS RIGEL 3DR CERVICAL INTERBODY 14 X 12 X 7MM",664420,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS RIGEL 3DR CERVICAL INTERBODY 14 X 12 X 8MM",690952,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS RIGEL 3DR CERVICAL INTERBODY 16 X 14 X 6MM",660048,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS RIGEL 3DR CERVICAL INTERBODY 16 X 14 X 7MM",690047,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS RIGEL 3DR CERVICAL INTERBODY 16 X 14 X 8MM",690085,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS RIGEL 3DR CERVICAL INTERBODY 16 X 9 X 9MM",691305,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"MIRUS SCREW VARIABLE 3.75",664028,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"MIRUS SCREW VARIABLE SELF DRILLING 12MM X 3.75MM",690312,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"NERVE WRAP 3MM X 2CM",663325,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,7668,,,5137.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2147.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2052.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2147.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3834,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6901.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2168.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2052.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2147.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7284.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6517.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2147.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4600.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2094.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2052.72,7284.6,
"NERVE WRAP 7mm X 4cm",663324,CDM,278,RC,C9353,HCPCS,"OUTPATIENT ",,,7523.2,,,5040.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2106.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2013.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2106.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3761.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6770.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2127.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2013.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2106.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7147.04,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6394.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2106.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4513.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2054.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2013.96,7147.04,
"NEVOS DBM PUTTY 2.5CC",664000,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2920,,,1956.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",817.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",781.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",817.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1460,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2628,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",825.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",781.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",817.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2774,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2482,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",817.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1752,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",797.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",781.68,2774,
"NF-SODIUM CHL 0.9% ADDV 100ML",5061601,CDM,258,RC,J7050,HCPCS,"OUTPATIENT ",,,37.44,,,25.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",33.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",148.75,104,,,,,0,"fee schedule","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",10.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",35.57,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",0.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",31.82,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.63,148.75,
"NUCEL AMNIOTIC SUSP 0.5CC",663972,CDM,278,RC,Q4139,HCPCS,"OUTPATIENT ",,,3380,,,2264.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",946.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",904.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",946.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1690,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3042,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",955.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",904.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",946.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3211,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2873,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",946.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2028,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",923.08,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",904.83,3211,
"NUCEL LARGE NC-1002",663980,CDM,278,RC,Q4100,HCPCS,"OUTPATIENT ",,,11000,,,7370,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2944.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3110.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2944.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3080,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10450,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9350,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3080,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3004.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2944.7,10450,
"NUCEL SMALL NC-1001",664002,CDM,278,RC,Q4100,HCPCS,"OUTPATIENT ",,,6660,,,4462.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1864.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1782.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1864.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3330,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5994,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1883.45,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1782.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1864.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6327,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5661,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1864.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3996,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1818.85,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1782.88,6327,
"NUCEL X-LARGE NC-1003",664029,CDM,278,RC,Q4100,HCPCS,"OUTPATIENT ",,,16000,,,10720,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4480,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4283.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4480,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",14400,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4524.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4283.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4480,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15200,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13600,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4480,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4369.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4283.2,15200,
"Odyssey Toric II IOL DRT150",691152,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,3980,,,2666.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1065.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3582,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1125.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1065.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1114.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3781,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3383,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2388,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1086.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1065.45,3781,
"Odyssey Toric II IOL DRT225",691304,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,3980,,,2666.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1065.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3582,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1125.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1065.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1114.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3781,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3383,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1114.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2388,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1086.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1065.45,3781,
"OPTHOPed 7.3mm Cannulated Screw, Fully Threaded, 72mm SS",690934,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,2204,,,1476.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1983.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",623.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",617.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2093.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1873.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1322.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",601.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59,2093.8,
"ORHTOPed 2.5mm x 300mm Ti Flexible IM Nail",690876,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3196,,,2141.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",894.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",855.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",894.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1598,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2876.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",903.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",855.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",894.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3036.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2716.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",894.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1917.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",872.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",855.57,3036.2,
"Orthoblast II 3cc",691444,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1480,,,991.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",414.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",396.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",414.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",740,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1332,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",418.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",396.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",414.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1406,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1258,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",414.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",888,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",404.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",396.2,1406,
"ORTHOBLAST II DBM PER 0.5CC",663510,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,564.56,,,378.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",158.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",151.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",158.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",564.56,100,,,,,0,"fee schedule","100% of total billed charges",508.1,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",159.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",151.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",158.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",536.33,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",479.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",158.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",338.74,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",154.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",151.13,564.56,
"ORTHOPed  6.5mm x 74mm Cannulated Screw",690763,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2112,,,1415.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",591.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",565.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",591.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1056,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1900.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",597.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",565.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",591.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2006.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1795.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",591.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1267.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",576.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",565.38,2006.4,
"ORTHOPed  7.3mm x 80mm Cannulated Screw",690762,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2204,,,1476.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1102,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1983.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",623.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",617.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2093.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1873.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1322.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",601.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59,2093.8,
"ORTHOPed  7.3mm x 82mm Cannulated Screw, fully threaded",690693,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2204,,,1476.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1102,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1983.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",623.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",617.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2093.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1873.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1322.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",601.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59,2093.8,
"ORTHOPed 2.0mm Titanium Flexible Nail",690698,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2844,,,1905.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",796.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",761.34,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",796.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1422,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2559.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",804.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",761.34,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",796.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2701.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2417.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",796.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1706.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",776.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",761.34,2701.8,
"ORTHOPed 2.7 mm Locking Compression Plate 6 Hole",691189,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2439.28,,,1634.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",683,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",653,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",683,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1219.64,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2195.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",689.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",653,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",683,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2317.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2073.39,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",683,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1463.57,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",666.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",653,2317.32,
"ORTHOPed 2.7mm X 10mm Cortical Screw",690641,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,204.6,,,137.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",204.6,100,,,,,0,"fee schedule","100% of total billed charges",184.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",173.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.77,204.6,
"ORTHOPed 2.7mm X 12mm Cortical Screw",690640,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,204.6,,,137.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",204.6,100,,,,,0,"fee schedule","100% of total billed charges",184.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",173.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.77,204.6,
"ORTHOPed 2.7mm X 14mm Cortical Screw",691243,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,204.6,,,137.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",204.6,100,,,,,0,"fee schedule","100% of total billed charges",184.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",173.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.77,204.6,
"ORTHOPed 2.7mm X 8mm Cortical Screw",690639,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,204.6,,,137.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",54.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",204.6,100,,,,,0,"fee schedule","100% of total billed charges",184.14,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",54.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",57.29,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",194.37,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",173.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",57.29,28,,,,,0,"percent of total billed charges ","28% of total billed charges",122.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",55.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",54.77,204.6,
"ORTHOPed 3.0mm Ti Flexible Nail",691366,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3196,,,2141.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",894.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",855.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",894.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1598,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2876.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",903.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",855.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",894.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3036.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2716.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",894.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1917.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",872.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",855.57,3036.2,
"OrthoPed 3.5 / 4.0mm Cannulated Screw Washer",691070,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,120,,,80.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",32.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",120,100,,,,,0,"fee schedule","100% of total billed charges",108,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",33.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",32.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",33.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",114,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",102,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",33.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",32.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",32.12,120,
"OrthoPed 3.5mm Locking T-Plate, 2 Hole Head",690973,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2014.04,,,1349.41,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",563.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",539.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",563.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1007.02,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1812.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",569.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",539.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",563.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1913.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1711.93,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",563.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1208.42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",550.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",539.16,1913.34,
"ORTHOPed 3.5mm X 10mm Cortical Screw",690642,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,224.68,,,150.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.68,100,,,,,0,"fee schedule","100% of total billed charges",202.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",190.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.15,224.68,
"ORTHOPed 3.5mm X 12mm Cortical Screw",690974,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,224.68,,,150.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.68,100,,,,,0,"fee schedule","100% of total billed charges",202.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",190.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.15,224.68,
"ORTHOPed 3.5mm X 14mm Cortical Screw",690975,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,224.68,,,150.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.68,100,,,,,0,"fee schedule","100% of total billed charges",202.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",190.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.15,224.68,
"ORTHOPed 3.5mm X 16mm Cortical Screw",690976,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,224.68,,,150.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.68,100,,,,,0,"fee schedule","100% of total billed charges",202.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",190.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.15,224.68,
"ORTHOPed 3.5mm X 18mm Cortical Screw",690977,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,224.68,,,150.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.68,100,,,,,0,"fee schedule","100% of total billed charges",202.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",190.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.15,224.68,
"ORTHOPed 3.5mm X 22mm Cortical Screw",690978,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,224.68,,,150.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",60.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.68,100,,,,,0,"fee schedule","100% of total billed charges",202.21,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",60.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",62.91,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",213.45,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",190.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",62.91,28,,,,,0,"percent of total billed charges ","28% of total billed charges",134.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",61.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",60.15,224.68,
"OrthoPED 4.0  X 36 Cannulated Screw MT",691087,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1620,,,1085.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",433.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",810,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1458,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",458.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",433.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",453.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1539,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1377,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",972,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",442.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",433.67,1539,
"OrthoPed 4.0mm Cannulated Screw MT, 40mm",691071,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1620,,,1085.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",433.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",810,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1458,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",458.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",433.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",453.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1539,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1377,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",972,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",442.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",433.67,1539,
"OrthoPed 4.0mm Cannulated Screw MT, 42mm",691225,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1700,,,1139,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",455.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1530,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",480.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",455.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",476,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1615,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1445,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1020,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",464.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",455.09,1615,
"OrthoPED 4.0mm x 34mm Cannulated Screw MT",691224,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1700,,,1139,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",455.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1530,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",480.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",455.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",476,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1615,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1445,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1020,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",464.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",455.09,1615,
"OrthoPed 4.0mm x 50mm Cannulated Screw MT",691085,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1620,,,1085.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",433.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",810,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1458,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",458.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",433.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",453.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1539,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1377,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",453.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",972,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",442.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",433.67,1539,
"ORTHOPed 4.5mm Cannulated Screw, Fully Threaded",690771,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1800,,,1206,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",504,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",481.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",504,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",900,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1620,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",509.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",481.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",504,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1710,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1530,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",504,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1080,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",491.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",481.86,1710,
"ORTHOPed 4.5mm x 40mm Cannulated Screw",690628,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1800,,,1206,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",504,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",481.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",504,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",900,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1620,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",509.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",481.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",504,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1710,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1530,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",504,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1080,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",491.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",481.86,1710,
"ORTHOPed 4.5mm x 48mm Cannulated Screw",690627,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2500,,,1675,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",669.25,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1250,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2250,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",707,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",669.25,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",700,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2375,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2125,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",700,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1500,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",682.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",669.25,2375,
"ORTHOPed 5.5mm x 55mm Cannulated Screw, medium threaded",690841,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2036,,,1364.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",570.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",545.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",570.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1018,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1832.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",575.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",545.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",570.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1934.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1730.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",570.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1221.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",556.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",545.04,1934.2,
"ORTHOPed 5.5mm x 85mm Cannulated Screw, medium threaded",690842,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2036,,,1364.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",570.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",545.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",570.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1018,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1832.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",575.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",545.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",570.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1934.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1730.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",570.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1221.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",556.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",545.04,1934.2,
"ORTHOPed 7.3mm Cannulated Screw, Fully Threaded, 62mm SS",690933,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2204,,,1476.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1102,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1983.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",623.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",617.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2093.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1873.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",617.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1322.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",601.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",59,2093.8,
"ORTHOPed FLEX NAIL Ti ROUND",663659,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1953.84,,,1309.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",547.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",523.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",547.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",976.92,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1758.46,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",552.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",523.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",547.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1856.15,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1660.76,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",547.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1172.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",533.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",523.04,1856.15,
"ORTHOPed SCREW CANN 4.5MM LP",663531,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1075.2,,,720.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",301.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",287.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",301.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",537.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",967.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",304.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",287.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",301.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1021.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",913.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",301.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",645.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",293.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",287.83,1021.44,
"ORTHOPed SCREW CANN FULL THREAD 7MM",663518,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1378,,,923.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",385.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",368.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",385.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",689,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1240.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",389.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",368.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",385.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1309.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1171.3,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",385.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",826.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",376.33,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",368.89,1309.1,
"OrthoPediatrics 2.7mm Locking Screw 10mm",691144,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,778.32,,,521.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",208.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",778.32,100,,,,,0,"fee schedule","100% of total billed charges",700.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",220.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",208.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",217.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",739.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",661.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",466.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",212.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",208.36,778.32,
"OrthoPediatrics 2.7mm Locking Screw 12mm",691145,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,778.32,,,521.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",208.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",778.32,100,,,,,0,"fee schedule","100% of total billed charges",700.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",220.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",208.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",217.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",739.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",661.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",466.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",212.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",208.36,778.32,
"OrthoPediatrics 2.7mm Locking Screw 14mm",691146,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,778.32,,,521.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",208.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",778.32,100,,,,,0,"fee schedule","100% of total billed charges",700.49,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",220.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",208.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",217.93,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",739.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",661.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",217.93,28,,,,,0,"percent of total billed charges ","28% of total billed charges",466.99,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",212.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",208.36,778.32,
"Orthopediatrics 3.5mm Locking Screw 10mm",691147,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,838.52,,,561.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.52,100,,,,,0,"fee schedule","100% of total billed charges",754.67,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",237.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",224.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",234.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",796.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",712.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",503.11,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",224.47,838.52,
"Orthopediatrics 3.5mm Locking Screw 16mm",691148,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,838.52,,,561.81,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",234.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",224.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",234.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.52,100,,,,,0,"fee schedule","100% of total billed charges",754.67,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",237.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",224.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",234.79,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",796.59,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",712.74,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",234.79,28,,,,,0,"percent of total billed charges ","28% of total billed charges",503.11,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",229,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",224.47,838.52,
"Orthopediatrics 3.5mm x 26mm Cannulated Screw, Short",691403,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1588,,,1063.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",444.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",425.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",444.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",794,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1429.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",449.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",425.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",444.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1508.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1349.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",444.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",952.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",433.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",425.11,1508.6,
"Orthopediatrics 4.0mm x 54mm Cannulated Screw ST",691365,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1700,,,1139,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",455.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1530,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",480.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",455.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",476,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1615,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1445,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1020,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",464.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",455.09,1615,
"OrthoPediatrics 4.0mm x 60mm Cannulated Screw ST",691364,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1700,,,1139,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",455.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1530,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",480.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",455.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",476,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1615,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1445,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",476,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1020,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",464.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",455.09,1615,
"Orthopediatrics 4.5mm x 38mm Cannulated Screw, Fully Threaded",691353,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2024,,,1356.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",541.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1012,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1821.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",572.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",541.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",566.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1922.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1720.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1214.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",552.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",541.82,1922.8,
"Orthopediatrics 4.5mm x 46mm Cannulated Screw, Fully Threaded",691352,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2024,,,1356.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",541.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1012,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1821.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",572.39,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",541.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",566.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1922.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1720.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",566.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1214.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",552.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",541.82,1922.8,
"OrthoPediatrics 7.3mm x 76mm Cannulated FT screw",691379,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2596,,,1739.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",726.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",694.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",726.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1298,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2336.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",734.15,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",694.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",726.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2466.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2206.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",726.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1557.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",708.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",694.95,2466.2,
"ORTHOPediatrics Wrist Fusion Plate, 2.7mm/3.5mm,99mm",691143,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9348,,,6263.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2617.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2502.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2617.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4674,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8413.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2643.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2502.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2617.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8880.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7945.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2617.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5608.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2552.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2502.46,8880.6,
"OT Unattended Electrical Therapy Charge",4411445,CDM,430,RC,G0283,HCPCS,"OUTPATIENT ",,,156,,,104.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",140.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.76,148.2,
"OTElectrical Stim (Unattended) - Non-Wound",4411445,CDM,430,RC,G0283,HCPCS,"OUTPATIENT ",,,156,,,104.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",140.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.76,148.2,
"PACEMAKER ACCOLADE",664322,CDM,278,RC,C1786,HCPCS,"OUTPATIENT ",,,21128,,,14155.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5915.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5655.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5915.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10564,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",19015.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5975,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5655.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5915.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20071.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17958.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5915.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12676.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5770.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5655.97,20071.6,
"PACEMAKER LEAD",664323,CDM,278,RC,C1898,HCPCS,"OUTPATIENT ",,,2908,,,1948.36,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",814.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",778.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",814.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1454,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2617.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",822.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",778.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",814.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2762.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2471.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",814.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1744.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",794.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",778.47,2762.6,
"PARA28 BG L-PLATE",663649,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4784,,,3205.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1339.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1280.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1339.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2392,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4305.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1352.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1280.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1339.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4544.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4066.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1339.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2870.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1306.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1280.68,4544.8,
"PARA28 HAMMERTUBE SYSTEM",663712,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5304,,,3553.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1485.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1419.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1485.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2652,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4773.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1499.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1419.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1485.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5038.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4508.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1485.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3182.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1448.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1419.88,5038.8,
"PARA28 SCREW BG LOCK 2.5MM",663634,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,992,,,664.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",265.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",992,100,,,,,0,"fee schedule","100% of total billed charges",892.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",280.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",265.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",277.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",942.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",843.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",595.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",270.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",265.56,992,
"PARA28 SCREW BG NL 2.5MM",663633,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,768,,,514.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",768,100,,,,,0,"fee schedule","100% of total billed charges",691.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",729.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",652.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",460.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",209.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.59,768,
"PARA28 SCREW MM CANN SHT THD HL 4.0",663672,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1456,,,975.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",407.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",389.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",407.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",728,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1310.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",411.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",389.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",407.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1383.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1237.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",407.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",873.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",397.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",389.77,1383.2,
"PARA28 SCREW RECON LOCK 3.5MM",663670,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,992,,,664.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",265.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",992,100,,,,,0,"fee schedule","100% of total billed charges",892.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",280.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",265.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",277.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",942.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",843.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",595.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",270.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",265.56,992,
"PARA28 SCREW RECON LOCK 4.2MM",663671,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1024,,,686.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",921.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",286.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",972.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",870.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",286.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",614.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.12,972.8,
"PARA28 T-PLATE COMPRESSION",663668,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6384,,,4277.28,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1787.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1709,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1787.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3192,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5745.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1805.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1709,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1787.52,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6064.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5426.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1787.52,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3830.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1743.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1709,6064.8,
"Paragon 28 Headless Countersink 3.5mm",691390,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,992,,,664.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",265.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",992,100,,,,,0,"fee schedule","100% of total billed charges",892.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",280.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",265.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",277.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",942.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",843.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",277.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",595.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",270.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",265.56,992,
"Paragon 28 Headless Screw 3.5mm x 30mm",691397,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1328,,,889.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",371.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",355.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",371.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",664,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1195.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",375.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",355.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",371.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1261.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1128.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",371.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",796.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",362.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",355.51,1261.6,
"Paragon 28 Locking Screw 2.7mm x 10mm",691392,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1056,,,707.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",282.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",950.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",298.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",282.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",295.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1003.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",897.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",633.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",288.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",282.69,1003.2,
"Paragon 28 Locking Screw 2.7mm x 14mm",691393,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1056,,,707.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",282.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",950.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",298.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",282.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",295.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1003.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",897.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",633.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",288.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",282.69,1003.2,
"Paragon 28 Locking Screw 3.5mm x 12mm",691395,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1052,,,704.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",294.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",281.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",294.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",526,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",946.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",297.51,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",281.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",294.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",999.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",894.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",294.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",631.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",287.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",281.62,999.4,
"Paragon 28 Locking Screw 3.5mm x 18mm",691396,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1056,,,707.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",282.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",950.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",298.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",282.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",295.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1003.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",897.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",633.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",288.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",282.69,1003.2,
"Paragon 28 Medium 5? Plate, Right",691391,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7568,,,5070.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2119.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2025.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2119.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3784,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6811.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2140.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2025.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2119.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7189.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6432.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2119.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4540.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2066.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2025.95,7189.6,
"Paragon 28 Nonlocking Screw 3.5mm x 14mm",691394,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,768,,,514.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",205.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",768,100,,,,,0,"fee schedule","100% of total billed charges",691.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",205.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",215.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",729.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",652.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",215.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",460.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",209.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",205.59,768,
"Paragon 28 Recon Locking Screw 2.7mm x 8mm",663669,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1056,,,707.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",282.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",950.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",298.64,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",282.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",295.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1003.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",897.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",295.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",633.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",288.39,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",282.69,1003.2,
"Patellar Ligament 10mm Preshaped",691629,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12800,,,8576,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3426.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11520,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3619.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3426.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3584,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12160,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10880,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7680,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3495.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3426.56,12160,
"Patellar Ligament, Preshaped 10mm",691657,CDM,278,RC,C1762,HCPCS,"OUTPATIENT ",,,12800,,,8576,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3426.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11520,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3619.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3426.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3584,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12160,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10880,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7680,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3495.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3426.56,12160,
"Phasix ST Mesh with Open Positioning 15cm x 20cm (6 x 8)",691263,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,23533.6,,,15767.51,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6589.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6299.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6589.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11766.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",21180.24,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6655.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6299.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6589.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",22356.92,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20003.56,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6589.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14120.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6427.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6299.94,22356.92,
"Phasix ST Mesh with Open Positioning 20cm x 25cm ( 8 X 10)",691264,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,38163.6,,,25569.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10685.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10216.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10685.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19081.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",34347.24,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10792.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",10216.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10685.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",36255.42,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",32439.06,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10685.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",22898.16,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",10422.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",10216.4,36255.42,
"Phasix ST Mesh with Open Positioning System 4 x 6",691360,CDM,278,RC,C1781,HCPCS,"OUTPATIENT ",,,12790.8,,,8569.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3581.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3424.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3581.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6395.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11511.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3617.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3424.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3581.42,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12151.26,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10872.18,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3581.42,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7674.48,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3493.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3424.1,12151.26,
"PLASTER SPLINT 3 X 15",664079,CDM,271,RC,A4580,HCPCS,"OUTPATIENT ",,,16.77,,,11.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",15.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.49,15.93,
"PLASTER SPLINT 4 X 15",664080,CDM,271,RC,Q4021,HCPCS,"OUTPATIENT ",,,20.52,,,13.75,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",18.47,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5.75,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19.49,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17.44,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5.75,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12.31,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5.49,19.49,
"PLASTER SPLINT 5 X 30",664081,CDM,271,RC,A4580,HCPCS,"OUTPATIENT ",,,16.77,,,11.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",15.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10.06,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4.49,15.93,
"PORT A CATH POWER PORT CLEAR VUE",680018,CDM,278,RC,C1788,HCPCS,"OUTPATIENT ",,,1100,,,737,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",294.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",550,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",990,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",311.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",294.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",308,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1045,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",935,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",308,28,,,,,0,"percent of total billed charges ","28% of total billed charges",660,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",300.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",294.47,1045,
"Pre-Shaped Patellar Ligament 10mm",690930,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13344,,,8940.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3736.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3572.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3736.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6672,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12009.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3773.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3572.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3736.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12676.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11342.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3736.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8006.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3644.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3572.19,12676.8,
"PSA Screen",2284103,CDM,301,RC,G0103,HCPCS,"OUTPATIENT ",,,261.5,,,175.21,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",73.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",73.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",25.29,100,,,,,0,"fee schedule","100% of BCBS PPO Fee schedule",235.35,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",0.68,,,104.00,,,0,"fee schedule","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,208.04,208.04,246.62,"1 through 10",other,"not separately reimbursment",73.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",25.7,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",73.22,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",248.43,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",26.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",222.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",73.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",156.9,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",26.21,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.68,248.43,
"Quadra Allure MP  (Pacemaker Generator)",691483,CDM,278,RC,C1785,HCPCS,"OUTPATIENT ",,,23600,,,15812,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6608,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6317.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6608,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",21240,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6674.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6317.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6608,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",22420,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20060,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6608,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6445.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6317.72,22420,
"Rayhack cortex screw 2.7mm, 14mm",691434,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 2.7mm, 16mm",691176,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 2.7mm, 18mm",690736,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 2.7mm, 20mm",691168,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack Cortex Screw 3.5mm, 12mm",691435,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 3.5mm, 14mm",691183,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 3.5mm, 16mm",691167,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 3.5mm, 18mm",690731,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 3.5mm, 20mm",690733,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 3.5mm, 22mm",690732,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack cortex screw 3.5mm, 24mm",691298,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,420,,,281.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",112.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",420,100,,,,,0,"fee schedule","100% of total billed charges",378,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",112.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",117.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",399,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",357,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",117.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",252,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",114.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",112.43,420,
"Rayhack locking screw 2.7mm, 14mm",691169,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,812,,,544.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",217.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812,100,,,,,0,"fee schedule","100% of total billed charges",730.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",217.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",227.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",771.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",690.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",487.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",221.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",217.37,812,
"Rayhack locking screw 2.7mm, 16mm",690735,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,812,,,544.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",217.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812,100,,,,,0,"fee schedule","100% of total billed charges",730.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",217.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",227.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",771.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",690.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",487.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",221.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",217.37,812,
"Rayhack locking screw 2.7mm, 18mm",691170,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,812,,,544.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",217.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812,100,,,,,0,"fee schedule","100% of total billed charges",730.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",217.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",227.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",771.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",690.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",487.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",221.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",217.37,812,
"Rayhack locking screw 2.7mm, 20mm",690734,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,812,,,544.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",217.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812,100,,,,,0,"fee schedule","100% of total billed charges",730.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",217.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",227.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",771.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",690.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",487.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",221.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",217.37,812,
"Rayhack Locking Screw 2.7mm, 22m",691299,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,812,,,544.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",217.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",812,100,,,,,0,"fee schedule","100% of total billed charges",730.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",217.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",227.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",771.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",690.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",227.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",487.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",221.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",217.37,812,
"Rigel SA Cervical 16w x 14d x 8h mm",691399,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,14900,,,9983,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4172,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3988.73,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4172,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7450,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13410,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4213.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3988.73,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4172,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14155,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12665,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4172,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8940,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4069.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3988.73,14155,
"RIGHT FEMORAL COMPONENT JOURNEY II SIZE 6",690249,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"ROOM/BED: Observation",4000001,CDM,762,RC,G0378,HCPCS,"OUTPATIENT ",,,264.5,,,177.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",70.81,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",238.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",70.81,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",251.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",224.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",158.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",70.81,251.28,
"RS CERV INTERBODY PLATE ZAV.",663858,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"RS CERVICAL PLATE 1 OR 2 LEVEL",663757,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"RS CERVICAL SPACER ZAV.",663859,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8000,,,5360,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2141.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2262.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2141.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2240,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7600,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6800,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2184.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2141.6,7600,
"RS DARKSTAR ROD MIS",663989,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1200,,,804,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",321.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1080,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",339.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",321.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",336,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1140,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1020,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",336,28,,,,,0,"percent of total billed charges ","28% of total billed charges",720,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",327.72,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",321.24,1140,
"RS DARKSTAR SET CAP",663988,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,800,,,536,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",214.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,100,,,,,0,"fee schedule","100% of total billed charges",720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",214.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",224,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",760,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",680,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",224,28,,,,,0,"percent of total billed charges ","28% of total billed charges",480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",218.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",214.16,800,
"RS RESTORE MINERALIZED GRAFT 2.5CC",664102,CDM,278,RC,C1762,HCPCS,"OUTPATIENT ",,,5368,,,3596.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1503.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1437.01,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1503.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2684,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4831.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1518.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1437.01,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1503.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5099.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4562.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1503.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3220.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1466,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1437.01,5099.6,
"RS SCREW DARKSTAR 7.5",663987,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5600,,,3752,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1499.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5040,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1583.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1499.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1568,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5320,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4760,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1568,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3360,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1529.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1499.12,5320,
"RS SCREW VAR-SELF DRILL 4.0",663758,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"SA60WF LENS",690147,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,536,,,359.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",150.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",143.49,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",150.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",482.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",143.49,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",150.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",509.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",455.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",150.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",321.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",146.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",143.49,509.2,
"SA6AT8 LENS",690654,CDM,276,RC,V2632,HCPCS,"OUTPATIENT ",,,1888,,,1264.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",528.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",505.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",528.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",1699.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",533.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",505.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",528.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1793.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1604.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",528.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1132.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",515.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",505.42,1793.6,
"SCS CHARGING SYSTEM",663886,CDM,274,RC,L8689,HCPCS,"OUTPATIENT ",,,7176,,,4807.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2009.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1921.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2009.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3588,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6458.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2029.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1921.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2009.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6817.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6099.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2009.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4305.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1959.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1921.02,6817.2,
"SD ALIGN RADIAL STEM",663485,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9548,,,6397.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2673.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2556,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2673.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4774,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8593.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2700.17,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2556,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2673.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9070.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8115.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2673.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5728.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2607.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2556,9070.6,
"SD AXIS PIN 2.5 X 50MM",690058,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1356,,,908.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",379.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",363,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",379.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",678,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1220.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",383.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",363,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",379.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1288.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1152.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",379.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",813.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",370.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",363,1288.2,
"SD BASE PLATE INTERNAL JOINT STABILIZER",663781,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,25148,,,16849.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7041.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6732.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7041.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12574,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",22633.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7111.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6732.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7041.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23890.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",21375.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7041.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15088.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6867.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6732.12,23890.6,
"SD CONNECTOR 2MM X 15",690153,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1748,,,1171.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",489.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",467.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",489.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",874,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1573.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",494.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",467.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",489.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1660.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1485.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",489.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1048.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",477.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",467.94,1660.6,
"SD K-WIRE 1.5",690157,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,72,,,48.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",19.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",72,100,,,,,0,"fee schedule","100% of total billed charges",64.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",19.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",20.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",68.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",61.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",20.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",43.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",19.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",19.27,72,
"SD LOCKING SCREW 2.8 X 10MM",690155,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,528,,,353.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",141.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528,100,,,,,0,"fee schedule","100% of total billed charges",475.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",149.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",141.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",501.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",448.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",316.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",144.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",141.35,528,
"SD LOCKING SCREW 2.8 X 7MM",690154,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,528,,,353.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",141.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528,100,,,,,0,"fee schedule","100% of total billed charges",475.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",149.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",141.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",501.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",448.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",316.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",144.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",141.35,528,
"SD LONG DISTAL RADIUS NAIL",690152,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3312,,,2219.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",927.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",886.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",927.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1656,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2980.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",936.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",886.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",927.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3146.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2815.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",927.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1987.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",904.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",886.62,3146.4,
"SD NAIL STANDARD METACARPAL 4.6",690151,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3292,,,2205.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",921.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",881.27,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",921.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1646,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2962.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",930.98,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",881.27,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",921.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3127.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2798.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",921.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1975.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",899.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",881.27,3127.4,
"SD PEG THREADED LOCK 2.3MM",663946,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,456,,,305.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",127.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",122.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",127.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",456,100,,,,,0,"fee schedule","100% of total billed charges",410.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",122.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",127.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",433.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",387.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",127.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",273.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",124.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",122.07,456,
"SD PIN 4.5",690195,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1424,,,954.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",398.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",381.2,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",398.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",712,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1281.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",381.2,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",398.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1352.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1210.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",398.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",854.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",388.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",381.2,1352.8,
"SD PLATE GEMINUS STD 3-HOLE",663944,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4180,,,2800.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1170.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1118.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1170.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2090,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3762,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1182.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1118.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1170.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3971,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3553,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1170.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2508,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1141.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1118.99,3971,
"SD RADIAL HEAD 24MM",690197,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,10116,,,6777.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2832.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2708.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2832.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5058,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9104.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2860.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2708.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2832.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9610.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8598.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2832.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6069.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2762.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2708.05,9610.2,
"SD RADIAL STEM 10MM",690196,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,10024,,,6716.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2806.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2683.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2806.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5012,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9021.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2834.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2683.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2806.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9522.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8520.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2806.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6014.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2737.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2683.42,9522.8,
"SD SCREW ALIGN RADIAL HEAD & LOCK",690062,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,9636,,,6456.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2698.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2579.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2698.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4818,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8672.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2725.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2579.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2698.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9154.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8190.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2698.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5781.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2631.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2579.56,9154.2,
"SD SCREW COMPRESSION 3.5 X 20MM",690057,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,636,,,426.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",636,100,,,,,0,"fee schedule","100% of total billed charges",572.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",179.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",170.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",178.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",604.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",540.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",381.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",173.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",170.26,636,
"SD SCREW COMPRESSION 3.5 X 22MM",690056,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,636,,,426.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",636,100,,,,,0,"fee schedule","100% of total billed charges",572.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",179.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",170.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",178.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",604.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",540.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",381.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",173.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",170.26,636,
"SD SCREW COMPRESSION 3.5 X 24MM",690193,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,488,,,326.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",488,100,,,,,0,"fee schedule","100% of total billed charges",439.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",463.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",414.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",292.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",130.64,488,
"SD SCREW COMPRESSION 3.5 X 26MM",664755,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,636,,,426.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",170.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",636,100,,,,,0,"fee schedule","100% of total billed charges",572.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",179.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",170.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",178.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",604.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",540.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",178.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",381.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",173.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",170.26,636,
"SD SCREW COMPRESSION 3.5 X 28MM",690194,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,488,,,326.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",488,100,,,,,0,"fee schedule","100% of total billed charges",439.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",463.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",414.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",292.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",130.64,488,
"SD SCREW COMPRESSION 3.5MM",663943,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,488,,,326.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",130.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",488,100,,,,,0,"fee schedule","100% of total billed charges",439.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",130.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",136.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",463.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",414.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",136.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",292.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",133.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",130.64,488,
"SD SCREW HI COMP LOCK 2.7MM",663945,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,456,,,305.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",127.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",122.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",127.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",456,100,,,,,0,"fee schedule","100% of total billed charges",410.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",122.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",127.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",433.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",387.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",127.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",273.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",124.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",122.07,456,
"SD Short Radius Nail",691671,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3416,,,2288.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",956.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",914.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",956.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1708,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3074.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",966.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",914.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",956.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3245.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2903.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",956.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2049.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",932.91,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",914.46,3245.2,
"SD Standard 4.0 Metacarpal Nail",691670,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3356,,,2248.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",939.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",898.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",939.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1678,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3020.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",949.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",898.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",939.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3188.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2852.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",939.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2013.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",916.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",898.4,3188.2,
"SD Unicortical Bone Screw 2.8 mm x 5.0 mm",691672,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,552,,,369.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",147.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",552,100,,,,,0,"fee schedule","100% of total billed charges",496.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",147.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",524.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",469.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",331.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",150.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",147.77,552,
"SD Unicortical Screw 2.8 mm ? 6.0 mm",691673,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,552,,,369.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",147.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",552,100,,,,,0,"fee schedule","100% of total billed charges",496.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",147.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",524.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",469.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",331.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",150.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",147.77,552,
"SD Unicortical Screw 2.8 mm ? 7.0 mm",691674,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,552,,,369.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",147.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",552,100,,,,,0,"fee schedule","100% of total billed charges",496.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",147.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",524.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",469.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",331.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",150.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",147.77,552,
"Sestamibi Add-On EFMC",6498451,CDM,343,RC,A9500,HCPCS,"OUTPATIENT ",,,2341.35,,,1568.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",655.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",626.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",655.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",2107.22,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",662.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",626.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",655.58,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2224.28,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1990.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",655.58,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1404.81,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",639.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",626.78,2224.28,
"Skeletal Dynamics 2.8mm x 6mm Unicortical Screw",691546,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,528,,,353.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",141.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528,100,,,,,0,"fee schedule","100% of total billed charges",475.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",149.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",141.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",501.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",448.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",316.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",144.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",141.35,528,
"Skeletal Dynamics 2.8mm x 8mm Unicortical Screw",691426,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,528,,,353.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",141.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528,100,,,,,0,"fee schedule","100% of total billed charges",475.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",149.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",141.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",147.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",501.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",448.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",147.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",316.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",144.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",141.35,528,
"Skeletal Dynamics 3.5mm x 14mm Non-Locking Cortical Screw",691585,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,248,,,166.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248,100,,,,,0,"fee schedule","100% of total billed charges",223.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",235.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",210.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",148.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.39,248,
"Skeletal Dynamics 3.5mm x 14mm titanium Cortical Locking Screw",691580,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,252,,,168.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",252,100,,,,,0,"fee schedule","100% of total billed charges",226.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",239.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",214.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",151.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.46,252,
"Skeletal Dynamics 3.5mm x 16mm Non-Locking Cortical Screw",691584,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,248,,,166.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248,100,,,,,0,"fee schedule","100% of total billed charges",223.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",235.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",210.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",148.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.39,248,
"Skeletal Dynamics 3.5mm x 16mm titanium Cortical Locking Screw",691581,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,252,,,168.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",67.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",252,100,,,,,0,"fee schedule","100% of total billed charges",226.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",67.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",70.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",239.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",214.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",70.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",151.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",68.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",67.46,252,
"Skeletal Dynamics 3.5mm x 18mm Polyaxial Non-Locking Cortical Screw",691586,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,248,,,166.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",66.39,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",248,100,,,,,0,"fee schedule","100% of total billed charges",223.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",66.39,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",69.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",235.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",210.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",69.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",148.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",67.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",66.39,248,
"Skeletal Dynamics Set Screw, 3.0mm x 2.0mm",690156,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,480,,,321.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",128.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",480,100,,,,,0,"fee schedule","100% of total billed charges",432,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",128.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",456,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",408,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",288,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",128.5,480,
"Skeletal Dynamics Ulnar Shortening Plate, Proximal",691587,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7448,,,4990.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2085.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1993.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2085.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3724,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6703.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2106.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1993.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2085.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7075.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6330.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2085.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4468.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2034.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1993.83,7075.6,
"SN 11 HOLE TIBIA PLATE",690417,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,21960,,,14713.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6148.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5878.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6148.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10980,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",19764,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6210.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5878.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6148.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20862,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",18666,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6148.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",13176,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5997.28,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5878.69,20862,
"SN 25mm Redapt Locking Screw",691634,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,1689.6,,,1132.03,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",473.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",452.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",473.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",844.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1520.64,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",477.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",452.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",473.09,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1605.12,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1436.16,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",473.09,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1013.76,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",461.43,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",452.31,1605.12,
"SN ANCHOR KNOTLESS BIORAPTOR",663222,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1164.8,,,780.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",326.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",311.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",326.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",582.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1048.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",329.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",311.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",326.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1106.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",990.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",326.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",698.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",318.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",311.82,1106.56,
"SN ARTICULAR INSERT JOURNEY II",690108,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN BIOSURE REGENESORB INTERFERENCE SCREW 9MM X 25MM",690240,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1164.8,,,780.42,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",326.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",311.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",326.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",582.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1048.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",329.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",311.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",326.14,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1106.56,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",990.08,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",326.14,28,,,,,0,"percent of total billed charges ","28% of total billed charges",698.88,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",318.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",311.82,1106.56,
"SN BIOSURE SYNC TIBIAL FIXATION DEVICE 9-10MM",690239,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,983.08,,,658.66,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",275.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",263.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",275.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",983.08,100,,,,,0,"fee schedule","100% of total billed charges",884.77,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",278.02,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",263.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",275.26,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",933.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",835.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",275.26,28,,,,,0,"percent of total billed charges ","28% of total billed charges",589.85,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",268.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",263.17,983.08,
"SN Bone Anchor (3)",690863,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3178.2,,,2129.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",889.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",889.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1589.1,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2860.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",898.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",850.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",889.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3019.29,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2701.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",889.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1906.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",867.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",850.8,3019.29,
"SN BONE CEMENT 40 GRAMS RALLY",664341,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1120,,,750.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",313.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",299.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",313.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",560,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1008,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",316.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",299.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",313.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1064,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",952,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",313.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",672,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",305.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",299.82,1064,
"SN BONE CEMENT W/O",663433,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,600,,,402,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",168,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",160.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",168,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",600,100,,,,,0,"fee schedule","100% of total billed charges",540,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",160.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",168,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",570,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",510,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",168,28,,,,,0,"percent of total billed charges ","28% of total billed charges",360,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",163.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",160.62,600,
"SN CANNULATED SCREW 6.5",610047,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1430.2,,,958.23,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",400.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",382.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",400.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",715.1,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1287.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",404.46,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",382.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",400.46,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1358.69,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1215.67,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",400.46,28,,,,,0,"percent of total billed charges ","28% of total billed charges",858.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",390.59,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",382.86,1358.69,
"SN CORTEX SCREW 3.5 X 22MM",690410,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,266.2,,,178.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",266.2,100,,,,,0,"fee schedule","100% of total billed charges",239.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",226.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",71.26,266.2,
"SN CORTEX SCREW 3.5 X 30MM",690413,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,266.2,,,178.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",266.2,100,,,,,0,"fee schedule","100% of total billed charges",239.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",226.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",71.26,266.2,
"SN CORTEX SCREW 3.5 X 32MM",690412,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,266.2,,,178.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",266.2,100,,,,,0,"fee schedule","100% of total billed charges",239.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",226.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",71.26,266.2,
"SN CORTEX SCREW 3.5 X 36MM",690414,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,266.2,,,178.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",266.2,100,,,,,0,"fee schedule","100% of total billed charges",239.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",226.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",71.26,266.2,
"SN CORTEX SCREW 3.5 X 38MM",690415,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,266.2,,,178.35,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",71.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",266.2,100,,,,,0,"fee schedule","100% of total billed charges",239.58,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",71.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",74.54,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",252.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",226.27,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",74.54,28,,,,,0,"percent of total billed charges ","28% of total billed charges",159.72,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",72.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",71.26,266.2,
"SN Cruciate Retaining Legion Nonporous Femoral Component Size 6, Left",691158,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,63540,,,42571.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17791.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",17009.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17791.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",31770,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",57186,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17969.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",17009.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17791.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",60363,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",54009,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17791.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",38124,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17352.77,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",17009.66,60363,
"SN Cruciate Retaining Legion Nonporous Femoral Component Size 7, Left",691058,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,44860,,,30056.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",12560.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12009.02,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",12560.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",22430,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",40374,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12686.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",12009.02,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",12560.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",42617,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",38131,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",12560.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",26916,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",12251.27,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",12009.02,42617,
"SN Cruciate Retaining Legion Porous CoCr Femoral Component, Right, Size 4",691221,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN END CAP",690512,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6150,,,4120.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1722,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1646.36,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1722,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3075,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5535,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1739.22,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1646.36,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1722,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5842.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5227.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1722,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3690,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1679.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1646.36,5842.5,
"SN ENDOBUTTON CL ULTRA Fixation Button 25mm",690944,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1057.6,,,708.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",296.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",296.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",528.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",951.84,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",299.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",296.13,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1004.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",898.96,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",296.13,28,,,,,0,"percent of total billed charges ","28% of total billed charges",634.56,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",288.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.12,1004.72,
"SN ENDOBUTTON CL ULTRA FIXATION BUTTON WITH 20MM CONTINUOUS LOOP SUTURE",690237,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,944.32,,,632.69,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",264.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",252.79,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",264.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",944.32,100,,,,,0,"fee schedule","100% of total billed charges",849.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",267.05,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",252.79,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",264.41,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",897.1,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",802.67,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",264.41,28,,,,,0,"percent of total billed charges ","28% of total billed charges",566.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",257.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",252.79,944.32,
"SN FAST FIX KIT 360 CURVED",664433,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2070,,,1386.9,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",579.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",554.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",579.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1035,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1863,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",585.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",554.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",579.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1966.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1759.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",579.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1242,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",565.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",554.14,1966.5,
"SN Genesis II Constrained Articular Insert 15mm Size 5-6",691335,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN Genesis II Left Non-Porous Tibial Baseplate Size 4",691172,CDM,278,RC,C776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN Genesis II Long Stem 10mm X 70mm",691101,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,17016,,,11400.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4764.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4555.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4764.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8508,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15314.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4812.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4555.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4764.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",16165.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14463.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4764.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10209.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4647.07,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4555.18,16165.2,
"SN GENESIS II RIGHT TIBIAL BASEPLATE SIZE 6",690577,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN GENESIS II TIBIAL BASEPLATE RIGHT",663080,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN GENESIS LEFT TIBIAL BASEPLATE SIZE 3",690669,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN GENESIS PATELLAR COMPONENT",664183,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN GENESIS PATELLAR COMPONENT 32mm",690576,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN HEALICOIL SUTURE ANCHOR 4.5MM",663188,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1360,,,911.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",364.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",680,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1224,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",384.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",364.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",380.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1292,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1156,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",816,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",371.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",364.07,1292,
"SN HEALICOIL SUTURE ANCHOR 5.5MM",663189,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1360,,,911.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",364.07,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",680,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1224,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",384.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",364.07,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",380.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1292,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1156,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",380.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",816,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",371.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",364.07,1292,
"SN JOURNEY FEMORAL COMPONENT LEFT SIZE 7",690756,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN JOURNEY FEMORAL COMPONENT LEFT SIZE 8",690374,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN JOURNEY FEMORAL COMPONENT RIGHT SIZE 5",664515,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,10800,,,7236,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3024,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2891.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3024,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9720,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3054.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2891.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3024,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10260,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9180,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3024,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6480,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2949.48,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2891.16,10260,
"SN Journey Femoral Component Right Size 8",690309,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN JOURNEY FEMORAL COMPONENT RIGHT, SIZE 4",690344,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12800,,,8576,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3426.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11520,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3619.84,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3426.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3584,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12160,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10880,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3584,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7680,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3495.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3426.56,12160,
"SN JOURNEY II ARTICULAR INSERT LEFT, SIZE 7-8 10MM",690757,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN JOURNEY II ARTICULAR INSERT LEFT, SIZE 7-8 11MM",690376,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN JOURNEY II ARTICULAR INSERT LEFT, SIZE 7-8 15MM",690994,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN JOURNEY II ARTICULAR INSERT LEFT, SIZE 7-8 9MM",691376,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN JOURNEY II ARTICULAR INSERT RIGHT, SIZE 3-4 13MM",690968,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Journey II Articular Insert Right, Size 7-8",691082,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Journey II Articular Insert, Left, 9mm Size 5-6",691477,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Journey II Articular Insert, Left, Size 5-6 10mm",691533,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Journey II Articular Insert, Left, Size 5-6 12mm",691140,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Journey II Articular Insert, Left, Size 5-6 15mm",691277,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Journey II BCS XLPE Articular Insert Right, Size 7-8",691109,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN JOURNEY II DEEP DISHED ARTICULAR INSERT RIGHT, SIZE 7-8 9MM",690829,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,8060,,,5400.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2256.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2157.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2256.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4030,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7254,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2279.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2157.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2256.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7657,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6851,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2256.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4836,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2201.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2157.66,7657,
"SN JOURNEY II FEMORAL COMPONENT LEFT, SIZE 4",690964,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN Journey II Femoral Component Left, Size 5",691185,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN Journey II Femoral Component Left, Size 6",691275,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN Journey II Femoral Component Right Size 7",691381,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN Journey II Left Articular Insert Size 3-4, 9mm",691482,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Journey II Right Articular Insert Size 5-6, 11mm",691669,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Journey Right Medial Tibia Baseplate, Size 3",691501,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"SN Journey Right Medial Tibia Insert, Size 3-4, 10mm",691502,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"SN JOURNEY TIB BASEPLATE LEFT, SIZE 4",663284,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN Journey Tibial Baseplate Size 7 Right",691081,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN JOURNEYII ARTICULAR INSERT LEFT, SIZE 3-4 12MM",690965,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN JOURNEYII ARTICULAR INSERT LEFT, SIZE 5-6 11MM",690929,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN JOURNEYII ARTICULAR INSERT RIGHT, SIZE 3-4 10MM",690345,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Legion Cruciate Retaining Femoral Component Size 5, Right",690102,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN Legion Cruciate Retaining Femoral Component Size 7, Left",691570,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN Legion Deep Dished with Journey Lock Articular Insert Size 1-2, 9mm",691270,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Legion Deep Dished with Journey Lock Articular Insert Size 3-4, 10mm",691470,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9600,,,6432,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2569.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8640,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2714.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2569.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2688,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9120,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8160,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2688,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5760,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2621.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2569.92,9120,
"SN Legion Deep Dished with Journey Lock Articular Insert Size 3-4, 11mm",691342,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Legion Deep Dished with Journey Lock Articular Insert Size 3-4, 9mm",691222,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN Legion Deep Dished with Journey Lock Articular Insert Size 5-6, 9mm",691571,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"SN LEGION FEMORAL COMPONENT Size 4, Right",691269,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN LEGION LEFT FEMORAL COMPONENT SIZE 4",690846,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,8000,,,5360,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2141.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2262.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2141.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2240,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7600,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6800,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2184.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2141.6,7600,
"SN LEGION LEFT FEMORAL COMPONENT SIZE 5",690668,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN Legion Pressfit Stem Straight 18mm x 160mm",691512,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,11341,,,7598.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3035.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5670.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10206.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3207.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3035.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3175.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10773.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9639.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6804.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3097.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3035.99,10773.95,
"SN Legion Pressfit Stem Straight 18mm x 220mm",691513,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,11341,,,7598.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3035.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5670.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10206.9,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3207.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3035.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3175.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10773.95,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9639.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3175.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6804.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3097.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3035.99,10773.95,
"SN LEGION REVISION TIBIAL BASEPLATE A/P 50mm, size 4, Left",690906,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,29380,,,19684.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8226.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7865.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8226.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14690,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",26442,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8308.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7865.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8226.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",27911,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",24973,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8226.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",17628,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8023.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7865.03,27911,
"SN LEGION RIGHT FEMORAL COMPONENT SIZE 6",690578,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN Legion Screw-On Femoral L-Wedge Size 6",691514,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,26112,,,17495.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7311.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6990.18,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7311.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13056,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",23500.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7384.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6990.18,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7311.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24806.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",22195.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7311.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15667.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7131.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6990.18,24806.4,
"SN Legion Short Cemented Stem14mm x 80mm",691336,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,10036,,,6724.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2810.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2686.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2810.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5018,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9032.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2838.18,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2686.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2810.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9534.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8530.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2810.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6021.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2740.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2686.64,9534.2,
"SN Legion Size 3-4, 11mm Dished Articular Insert XLPE",691138,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN Legion Size 5-6, 15mm XLPE Dished Articular Insert",691159,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN Legion Tibial Cone 24 I.D.",691511,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,53688,,,35970.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",15032.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",14372.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",15032.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",26844,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",48319.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15182.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",14372.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",15032.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",51003.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",45634.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",15032.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",32212.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",14662.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",14372.28,51003.6,
"SN LEGION XLPE DISHED ARTICULAR INSERT",664182,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN LEGION XLPE DISHED ARTICULAR INSERT SIZE 5-6 11MM",690579,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,5400,,,3618,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1445.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4860,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1527.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1445.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1512,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5130,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4590,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1512,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1474.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1445.58,5130,
"SN Legion XLPE Dished Articular Insert Size 5-6, 18mm",691059,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN LOCKING SCREW 3.5 X 40MM",690416,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1388,,,929.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",388.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",371.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",388.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",694,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1249.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",392.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",371.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",388.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1318.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1179.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",388.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",832.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",379.06,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",371.57,1318.6,
"SN MAGNUM KNOTLESS ANCHOR",664091,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4740,,,3175.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1327.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1268.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1327.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2370,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4266,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1340.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1268.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1327.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4503,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4029,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1327.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2844,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1294.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1268.9,4503,
"SN OR30 Oxinium Dual Mobility Liner 44/56",691639,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9500,,,6365,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2543.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8550,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2686.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2543.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2660,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9025,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8075,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2594.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2543.15,9025,
"SN OR3O 28mm x 42mm Dual Mobility Insert",691551,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2000,,,1340,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",535.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",565.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",535.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",560,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1900,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1700,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",546.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",535.4,1900,
"SN OR3O Dual Mobility Insert 28/44",691638,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9500,,,6365,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2543.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8550,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2686.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2543.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2660,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9025,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8075,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2594.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2543.15,9025,
"SN OR3O Dual Mobility Liner 42/54",691549,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,3200,,,2144,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",856.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2880,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",904.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",856.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",896,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3040,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2720,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1920,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",873.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",856.64,3040,
"SN Oxinium Femoral  Head 28mm 12/14 Taper",691552,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4000,,,2680,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1070.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3600,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1131.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1070.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1120,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3800,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3400,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2400,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1092.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1070.8,3800,
"SN Oxinium Femoral  Head 28mm O.D. -3, 12/14 Taper",691637,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9500,,,6365,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2543.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8550,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2686.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2543.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2660,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9025,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8075,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2594.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2543.15,9025,
"SN PANTA 5.0mm Partially Threaded C-Screw size 65",691411,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,3510,,,2351.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",982.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",939.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",982.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3159,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",992.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",939.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",982.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3334.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2983.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",982.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2106,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",958.58,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",939.63,3334.5,
"SN PANTA NAIL. 11MM DIA. X 180MM",690513,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,27183,,,18212.61,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7276.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13591.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",24464.7,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7687.35,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7276.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7611.24,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25823.85,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23105.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7611.24,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16309.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7423.68,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7276.89,25823.85,
"SN PANTA SCREW 5.0MM FULLY THREADED SIZE 22",690509,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2216.8,,,1485.26,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",620.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",593.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",620.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1108.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1995.12,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",626.91,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",593.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",620.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2105.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1884.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",620.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1330.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",605.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",593.44,2105.96,
"SN PANTA SCREW 5.0MM FULLY THREADED SIZE 26",690510,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2328,,,1559.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",651.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",623.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",651.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1164,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2095.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",658.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",623.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",651.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2211.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1978.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",651.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1396.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",635.78,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",623.21,2211.6,
"SN PANTA SCREW 5.0MM PARTIALLY THREADED SIZE 80",690511,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3916,,,2623.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1096.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1048.31,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1096.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1958,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3524.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1107.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1048.31,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1096.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3720.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3328.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1096.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2349.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1069.46,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1048.31,3720.2,
"SN Porous Tibia Baseplate with Journey Lock Left, Size 3",691462,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12000,,,8040,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3212.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3393.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3212.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3360,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11400,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10200,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3277.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3212.4,11400,
"SN Porous Tibia Baseplate with Journey Lock Left, Size 6",691572,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN Porous Tibia Baseplate with Journey Lock Right, Size 2",691271,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN Porous Tibia Baseplate with Journey Lock Right, Size 4",691220,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SN R3 Three Hole 54mm OD Hemispherical Stiktite Coated Shell",691548,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14000,,,9380,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3920,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3747.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3920,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12600,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3959.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3747.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3920,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13300,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11900,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3920,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8400,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3823.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3747.8,13300,
"SN Rally HV Antibiotic Bone Cement",663551,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1120,,,750.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",313.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",299.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",313.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",560,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1008,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",316.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",299.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",313.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1064,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",952,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",313.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",672,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",305.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",299.82,1064,
"SN Redapt 56mm OD Modular Shell",691640,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,27192,,,18218.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7613.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7279.3,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7613.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",13596,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",24472.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7689.9,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",7279.3,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7613.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",25832.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",23113.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7613.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",16315.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",7426.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",7279.3,25832.4,
"SN Reflection 6.5mm x 30mm Spherical Head Cancellous Screw",691633,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,1374,,,920.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",384.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",367.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",384.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",687,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1236.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",367.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",384.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1305.3,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1167.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",384.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",824.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",375.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",367.82,1305.3,
"SN Regeneten Bioinductive Rotator Cuff Implant",664164,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15163.12,,,10159.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4245.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4059.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4245.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7581.56,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13646.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4288.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4059.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4245.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14404.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12888.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4245.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9097.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4141.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4059.17,14404.96,
"SN RIGHT FEMORAL COMPONENT JOURNEY II",690106,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14400,,,9648,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3854.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4072.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3854.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4032,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13680,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12240,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4032,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3932.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3854.88,13680,
"SN RIGHT TIBIAL BASEPLATE JOURNEY",690107,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7500,,,5025,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2100,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2007.75,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2100,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6750,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2121,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2007.75,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2100,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7125,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6375,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2100,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4500,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2048.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2007.75,7125,
"SN Round Porous Patella, Size 29mm",691343,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"SN Round Porous Patella, Size 32mm",691223,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"SN Size 16 Standard Offset Synergy Porous Plus Femoral Component",691635,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9500,,,6365,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2543.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8550,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2686.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2543.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2660,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9025,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8075,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2660,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5700,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2594.45,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2543.15,9025,
"SN Spherical Head Reflection 6.5 x 25mm Cancellous Screw",691550,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,400,,,268,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",107.08,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",400,100,,,,,0,"fee schedule","100% of total billed charges",360,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",107.08,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",112,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",380,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",340,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",112,28,,,,,0,"percent of total billed charges ","28% of total billed charges",240,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",109.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",107.08,400,
"SN Synergy Standard Offset, Size 13, Porous Plus HA Coated Femoral Stem 12/14 Taper",691553,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14000,,,9380,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3920,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3747.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3920,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12600,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3959.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3747.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3920,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13300,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11900,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3920,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8400,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3823.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3747.8,13300,
"SN TENDON ANCHORS (8)",664165,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4091.92,,,2741.59,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1145.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1095.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1145.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2045.96,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3682.73,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1157.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1095.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1145.74,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3887.32,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3478.13,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1145.74,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2455.15,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1117.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1095.41,3887.32,
"SN Tibia Baseplate w/ Journey Lock Right, Size 3",691341,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7200,,,4824,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1927.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6480,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2036.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1927.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2016,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6840,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6120,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2016,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4320,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1966.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1927.44,6840,
"SO ACUMED PLATE LONG NARROW PROXIMAL VDR RIGHT",690040,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"SO ACUMED SCREW CORT 3.5MM",663794,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,504,,,337.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",134.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",504,100,,,,,0,"fee schedule","100% of total billed charges",453.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.53,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",134.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",141.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",478.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",428.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",141.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",302.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",137.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",134.92,504,
"SO ACUTRAK 2 SCREW 4.7",664026,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2440,,,1634.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",683.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",653.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",683.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1220,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2196,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",690.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",653.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",683.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2318,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2074,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",683.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1464,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",666.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",653.19,2318,
"SO PEG LOCK CORT",663722,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,516,,,345.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",138.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",516,100,,,,,0,"fee schedule","100% of total billed charges",464.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",138.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",144.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",490.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",438.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",144.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",309.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",140.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",138.13,516,
"SO SCREW LOCK HEXALOBE",663250,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,452,,,302.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",126.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",121,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",126.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",452,100,,,,,0,"fee schedule","100% of total billed charges",406.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",127.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",121,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",126.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",429.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",384.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",126.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",271.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",123.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",121,452,
"SO WRIST PLATE",663247,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5392,,,3612.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1443.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2696,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4852.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1524.86,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1443.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1509.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5122.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4583.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3235.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1472.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1443.44,5122.4,
"SODIUM CHLORIDE  0.9% 1000ml",5085005,CDM,636,RC,J7030,HCPCS,"OUTPATIENT ",,,5.7,,,3.82,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5.7,100,,,,,0,"fee schedule","100% of total billed charges",5.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",0.96,,,104.00,,,0,"fee schedule","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,1960.91,1960.91,1960.91,"1 through 10",other,"not separately reimbursment",1.61,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",1.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5.42,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",2.55,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",4.85,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3.42,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.55,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.96,5.7,
"SODIUM CHLORIDE 0.9% 100ml",80085215,CDM,258,RC,J7050,HCPCS,"OUTPATIENT ",,,31.62,,,21.19,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",28.46,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",0.93,,,104.00,,,0,"fee schedule","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",8.85,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",30.04,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",0.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",26.88,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8.85,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18.97,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.63,30.04,
"SODIUM CHLORIDE 0.9% 250ml",5085213,CDM,258,RC,J7030,HCPCS,"OUTPATIENT ",,,12.84,,,8.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",11.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",0.96,,,104.00,,,0,"fee schedule","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,1960.91,1960.91,1960.91,"1 through 10",other,"not separately reimbursment",3.63,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2.5,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",3.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",2.55,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",10.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7.7,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2.55,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.96,12.2,
"SODIUM CHLORIDE 0.9% 50ML",80085216,CDM,258,RC,J7050,HCPCS,"OUTPATIENT ",,,3.42,,,2.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.08,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",0.8,,,104.00,,,0,"fee schedule","104% of AR medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",0.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.63,100,,,,,0,"fee schedule","100% of AR Medicaid fee Schedule",0.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.25,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",0.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule ",2.91,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.64,102,,,,,0,"fee Schedule ","102% of AR medicaid fee schedule",0.63,3.25,
"SpeedGraft QuadLink Tendon",691660,CDM,278,RC,C1762,HCPCS,"OUTPATIENT ",,,11400,,,7638,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3192,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3051.78,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3192,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5700,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10260,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3223.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3051.78,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3192,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10830,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9690,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3192,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3113.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3051.78,10830,
"SpeedPatch PET 25 x 30mm",691595,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12000,,,8040,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3212.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3393.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3212.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3360,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11400,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10200,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3360,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3277.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3212.4,11400,
"SPINE SOURCE SPACER VBR SM",663990,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"SPINE STIM TRIAL LEAD",663273,CDM,278,RC,C1897,HCPCS,"OUTPATIENT ",,,4000,,,2680,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1070.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3600,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1131.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1070.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1120,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3800,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3400,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1120,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2400,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1092.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1070.8,3800,
"Spine Wave 14mm Variable Self Tapping Screw",691402,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5000,,,3350,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1338.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1400,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1414,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1338.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1400,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4750,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4250,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1400,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1365.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1338.5,4750,
"SPLINT POSTERIOR LEG",663914,CDM,272,RC,L4387,HCPCS,"OUTPATIENT ",,,63.12,,,42.29,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",17.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",16.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",17.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",56.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",16.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",17.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",59.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",53.65,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",17.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",37.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",17.24,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",16.9,59.96,
"STOCKINETTE TUBULAR 3 PER YARD",3.53,CDM,270,RC,A6457,HCPCS,"OUTPATIENT ",,,3.54,,,2.37,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",0.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",0.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.19,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",0.99,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.36,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.01,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",0.99,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",0.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.95,3.36,
"STOCKINETTE TUBULAR 4 PER YARD",662961,CDM,270,RC,A6457,HCPCS,"OUTPATIENT ",,,42.63,,,28.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",11.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",11.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",38.37,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.06,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",11.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",11.94,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",40.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",36.24,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",11.94,28,,,,,0,"percent of total billed charges ","28% of total billed charges",25.58,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",11.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",11.41,40.5,
"Stravix PL 2x4cm PS61024",691641,CDM,278,RC,Q4133,HCPCS,"OUTPATIENT ",,,6680,,,4475.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1870.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1788.24,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1870.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3340,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6012,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1889.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1788.24,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1870.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6346,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5678,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1870.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4008,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1824.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1788.24,6346,
"STRYKER 3 HOLE PLATE DISTAL FIBULA",690216,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3077.88,,,2062.18,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",861.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",823.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",861.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1538.94,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2770.09,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",870.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",823.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",861.81,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2923.99,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2616.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",861.81,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1846.73,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",840.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",823.95,2923.99,
"Stryker 3.5 x  30mm Locking Screw",690712,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,940,,,629.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",251.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",940,100,,,,,0,"fee schedule","100% of total billed charges",846,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",265.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",251.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",263.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",893,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",799,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",564,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",256.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",251.64,940,
"Stryker 3.5 x 28mm Locking Screw",690715,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,940,,,629.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",251.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",940,100,,,,,0,"fee schedule","100% of total billed charges",846,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",265.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",251.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",263.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",893,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",799,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",564,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",256.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",251.64,940,
"Stryker 3.5 x 32mm Locking Screw",690714,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,940,,,629.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",251.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",940,100,,,,,0,"fee schedule","100% of total billed charges",846,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",265.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",251.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",263.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",893,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",799,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",263.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",564,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",256.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",251.64,940,
"Stryker 3.5 x 32mm Non-Locking Screw",690713,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,512,,,343.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",137.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,100,,,,,0,"fee schedule","100% of total billed charges",460.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",144.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",137.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",143.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",486.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",435.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",307.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",139.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",137.06,512,
"STRYKER 3.5mm x 14 mm non locking Cortex Screw",690220,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,512,,,343.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",137.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,100,,,,,0,"fee schedule","100% of total billed charges",460.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",144.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",137.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",143.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",486.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",435.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",307.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",139.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",137.06,512,
"Stryker 3.5mm x 16mm Non Locking Screw",690883,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,512,,,343.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",137.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,100,,,,,0,"fee schedule","100% of total billed charges",460.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",144.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",137.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",143.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",486.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",435.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",307.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",139.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",137.06,512,
"Stryker 3.5mm x 18mm Non Locking Screw",690885,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,512,,,343.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",137.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,100,,,,,0,"fee schedule","100% of total billed charges",460.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",144.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",137.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",143.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",486.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",435.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",307.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",139.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",137.06,512,
"Stryker 6 Hole Narrow Compression Plate",690884,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2228,,,1492.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",623.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",623.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1114,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2005.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",630.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",596.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",623.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2116.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1893.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",623.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1336.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",608.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",596.44,2116.6,
"Stryker 7 Hole Straight Broad Compression Plate",690882,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2228,,,1492.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",623.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",596.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",623.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1114,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2005.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",630.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",596.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",623.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2116.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1893.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",623.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1336.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",608.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",596.44,2116.6,
"STRYKER CORTEX SCREW 3.5MM X 12MM",690218,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,482,,,322.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",482,100,,,,,0,"fee schedule","100% of total billed charges",433.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",457.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",409.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",129.03,482,
"STRYKER CORTICAL SCREW 22MM X 2.7MM",690212,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,482,,,322.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",482,100,,,,,0,"fee schedule","100% of total billed charges",433.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",457.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",409.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",129.03,482,
"STRYKER DRILL BIT 2.5MM",690366,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,599.88,,,401.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",167.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",160.59,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",167.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.88,100,,,,,0,"fee schedule","100% of total billed charges",539.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",160.59,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",167.97,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",569.89,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",509.9,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",167.97,28,,,,,0,"percent of total billed charges ","28% of total billed charges",359.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",163.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",160.59,599.88,
"Stryker EasyFuse Dynamic Compression System 20mm x 20mm",691065,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7092,,,4751.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1985.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1898.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1985.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3546,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6382.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2005.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1898.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1985.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6737.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6028.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4255.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1936.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1898.53,6737.4,
"STRYKER KNEE HEADLESS PINS",663185,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2550,,,1708.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",714,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",682.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",714,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1275,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2295,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",721.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",682.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",714,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2422.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2167.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",714,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1530,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",696.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",682.64,2422.5,
"STRYKER LAPIPLASTY SYSTEM",663892,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,18240,,,12220.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5107.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4882.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5107.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16416,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5158.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4882.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5107.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17328,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15504,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5107.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10944,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4981.34,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4882.85,17328,
"STRYKER LOCKING SCREW 3.5 X 16MM",690362,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1025.24,,,686.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",287.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",287.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512.62,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",922.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",287.07,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",973.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",871.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",287.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges",615.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.46,973.98,
"STRYKER LOCKING SCREW 3.5 X 18MM",690363,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1025.24,,,686.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",287.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",274.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",287.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512.62,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",922.72,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.94,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",274.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",287.07,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",973.98,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",871.45,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",287.07,28,,,,,0,"percent of total billed charges ","28% of total billed charges",615.14,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",279.99,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",274.46,973.98,
"STRYKER LOCKING SCREW 3.5 X 24MM",690364,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1004.64,,,673.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",281.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",268.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",281.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",502.32,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",904.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",284.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",268.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",281.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",954.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",853.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",281.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",602.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",274.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",268.94,954.41,
"STRYKER LOCKING SCREW 3.5 X 26MM",690365,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1004.64,,,673.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",281.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",268.94,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",281.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",502.32,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",904.18,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",284.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",268.94,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",281.3,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",954.41,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",853.94,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",281.3,28,,,,,0,"percent of total billed charges ","28% of total billed charges",602.78,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",274.37,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",268.94,954.41,
"STRYKER LOCKING SCREW 3.5MM X 12MM",690217,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,885.92,,,593.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",885.92,100,,,,,0,"fee schedule","100% of total billed charges",797.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",250.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",237.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",248.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",841.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",753.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",531.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",241.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.16,885.92,
"STRYKER LOCKING SCREW 3.5MM X 14MM",690219,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,885.92,,,593.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",885.92,100,,,,,0,"fee schedule","100% of total billed charges",797.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",250.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",237.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",248.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",841.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",753.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",531.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",241.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.16,885.92,
"Stryker Low Profile Rayhack Ulna Shortening Plate",663976,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5436,,,3642.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1522.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1455.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1522.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2718,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4892.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1537.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1455.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1522.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5164.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4620.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1522.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3261.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1484.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1455.22,5164.2,
"STRYKER MEDIAL RIGHT LISFRANC PLATE",690361,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7208.88,,,4829.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2018.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1929.82,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2018.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3604.44,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6487.99,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2038.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1929.82,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2018.49,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6848.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6127.55,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2018.49,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4325.33,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1968.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1929.82,6848.44,
"Stryker MIS Calcaneal Plate",690711,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6976,,,4673.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1953.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1867.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1953.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3488,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6278.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1972.81,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1867.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1953.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6627.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5929.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1953.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4185.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1905.15,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1867.48,6627.2,
"STRYKER PIN 5.0",690135,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2400,,,1608,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",642.48,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2160,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",678.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",642.48,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",672,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2280,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2040,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",672,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1440,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",655.44,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",642.48,2280,
"STRYKER PLATE 9 HOLE RIGHT",690129,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7600,,,5092,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2128,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2034.52,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2128,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6840,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2149.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2034.52,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2128,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7220,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6460,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2128,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4560,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2075.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2034.52,7220,
"STRYKER SCREW LOCKING 3.5 X 20MM",690134,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,885.92,,,593.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",885.92,100,,,,,0,"fee schedule","100% of total billed charges",797.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",250.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",237.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",248.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",841.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",753.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",531.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",241.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.16,885.92,
"STRYKER SCREW LOCKING 3.5 X 26MM",690133,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,885.92,,,593.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",885.92,100,,,,,0,"fee schedule","100% of total billed charges",797.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",250.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",237.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",248.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",841.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",753.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",531.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",241.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.16,885.92,
"STRYKER SCREW LOCKING 3.5 X 40MM",690130,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,885.92,,,593.57,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",237.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",885.92,100,,,,,0,"fee schedule","100% of total billed charges",797.33,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",250.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",237.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",248.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",841.62,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",753.03,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",248.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",531.55,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",241.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",237.16,885.92,
"STRYKER SCREW NONLOCKING 3.5 X 34MM",690132,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,512,,,343.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",137.06,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",512,100,,,,,0,"fee schedule","100% of total billed charges",460.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",144.79,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",137.06,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",143.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",486.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",435.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",143.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",307.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",139.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",137.06,512,
"STRYKER SCREW NONLOCKING 3.5 X 38MM",690131,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,482,,,322.94,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",129.03,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",482,100,,,,,0,"fee schedule","100% of total billed charges",433.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",129.03,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",134.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",457.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",409.7,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",134.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",289.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",131.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",129.03,482,
"STRYKER SCREW PT 5.0 ASNIS",663610,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,787.92,,,527.91,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",220.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",210.93,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",220.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",787.92,100,,,,,0,"fee schedule","100% of total billed charges",709.13,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",222.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",210.93,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",220.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",748.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",669.73,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",220.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",472.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",215.18,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",210.93,787.92,
"Stryker Superior Midshaft Right Clavicle Plate",691363,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5840,,,3912.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1635.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1563.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1635.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2920,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5256,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1651.55,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1563.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1635.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5548,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4964,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1635.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3504,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1594.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1563.37,5548,
"Synthes 2.7mm Cortex Screw Self Tapping 14mm",690881,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,200.12,,,134.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.12,100,,,,,0,"fee schedule","100% of total billed charges",180.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",190.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",170.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",120.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.57,200.12,
"Synthes 2.7mm Cortex Screw Self Tapping 14mm T8 SD REC 14",690879,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,198.84,,,133.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",55.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",55.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",198.84,100,,,,,0,"fee schedule","100% of total billed charges",178.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",55.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",188.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",169.01,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",55.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",119.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.23,198.84,
"Synthes 2.7mm Cortex Screw Self Tapping 16mm",690880,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,200.12,,,134.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.57,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",200.12,100,,,,,0,"fee schedule","100% of total billed charges",180.11,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.59,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.57,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",56.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",190.11,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",170.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",56.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",120.07,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.57,200.12,
"Synthes 2.7mm Cortex Screw Self Tapping 16mm T8 SD REC 16",690319,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,198.84,,,133.22,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",55.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",53.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",55.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",198.84,100,,,,,0,"fee schedule","100% of total billed charges",178.96,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.23,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",53.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",55.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",188.9,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",169.01,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",55.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",119.3,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",54.3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",53.23,198.84,
"Synthes 3.5 LCP Plate 10 hole",691504,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1829.16,,,1225.54,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",512.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",489.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",512.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",914.58,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1646.24,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",517.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",489.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",512.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1737.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1554.79,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",512.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1097.5,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",499.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",489.67,1737.7,
"Synthes 3.5 mm X 14mm Cortex Screws, self-tapping",691219,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,155.72,,,104.33,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.69,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",155.72,100,,,,,0,"fee schedule","100% of total billed charges",140.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.69,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",147.93,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.43,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.69,155.72,
"Synthes 3.5mm X 12mm Cortex Self-tapping Screw",691053,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,109.88,,,73.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.88,100,,,,,0,"fee schedule","100% of total billed charges",98.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.41,109.88,
"Synthes 3.5mm X 14mm Cortex Self-tapping Screw",690951,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,109.88,,,73.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.88,100,,,,,0,"fee schedule","100% of total billed charges",98.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.41,109.88,
"Synthes 3.5mm X 16mm Cortex Self-tapping Screw",690988,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,109.88,,,73.62,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",29.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",109.88,100,,,,,0,"fee schedule","100% of total billed charges",98.89,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.07,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",29.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",30.77,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",104.39,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",93.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",30.77,28,,,,,0,"percent of total billed charges ","28% of total billed charges",65.93,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",29.41,109.88,
"TENDON PROTECTOR SHEET 2 X 2 TENOGLIDE",663370,CDM,278,RC,C9356,HCPCS,"OUTPATIENT ",,,12732.44,,,8530.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3565.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3408.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3565.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6366.22,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11459.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3600.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3408.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3565.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12095.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10822.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3565.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7639.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3477.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3408.47,12095.82,
"TENDON PROTECTOR SHEET 4 X 5 TENOGLIDE",691370,CDM,278,RC,C9356,HCPCS,"OUTPATIENT ",,,12732.44,,,8530.73,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3565.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3408.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3565.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6366.22,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11459.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3600.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3408.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3565.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12095.82,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10822.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3565.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7639.46,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3477.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3408.47,12095.82,
"Tesera SC Locking Cover Plate (Gen 2)",664248,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3200,,,2144,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",856.64,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1600,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2880,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",904.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",856.64,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",896,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3040,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2720,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",896,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1920,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",873.92,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",856.64,3040,
"Tesera SC SA Cervical Cage, 16mm x 13.5mm x 7mm, 2? Lordosis, T3",691063,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,17000,,,11390,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4760,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4550.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4760,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15300,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4807.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4550.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4760,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",16150,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14450,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4760,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4642.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4550.9,16150,
"TESERA SC SELF DRILLING SCREW 3.5 X 12MM",690167,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1600,,,1072,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",448,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",428.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",448,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1440,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",452.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",428.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",448,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1520,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1360,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",448,28,,,,,0,"percent of total billed charges ","28% of total billed charges",960,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",436.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",428.32,1520,
"TESERA SC SELF DRILLING SCREW 3.5 X 14MM",690897,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1600,,,1072,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",448,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",428.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",448,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",800,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1440,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",452.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",428.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",448,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1520,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1360,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",448,28,,,,,0,"percent of total billed charges ","28% of total billed charges",960,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",436.96,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",428.32,1520,
"TESERA SC STAND ALONE CERVICAL CAGE 16 X 1.5 X 7MM",690166,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,17000,,,11390,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4760,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4550.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4760,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",15300,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4807.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4550.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4760,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",16150,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",14450,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4760,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4642.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4550.9,16150,
"TORNIER AEQUALIS SHOULDER  CENTRAL SCREW 6.5 X 25MM",663965,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2803.2,,,1878.14,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",784.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",750.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",784.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1401.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2522.88,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",792.74,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",750.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",784.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2663.04,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2382.72,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",784.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1681.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",765.55,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",750.42,2663.04,
"TORNIER AEQUALIS SHOULDER PERIPHERAL SCREW 5.0 X 22MM",663966,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2000,,,1340,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",535.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",565.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",535.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",560,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1900,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1700,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",546.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",535.4,1900,
"TORNIER AEQUALIS SHOULDER PERIPHERAL SCREW 5.0 X 34MM",690909,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,835.2,,,559.58,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",233.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",223.58,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",233.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",835.2,100,,,,,0,"fee schedule","100% of total billed charges",751.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.19,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",223.58,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",233.86,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",793.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",709.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",233.86,28,,,,,0,"percent of total billed charges ","28% of total billed charges",501.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",228.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",223.58,835.2,
"TORNIER AEQUALIS SHOULDER REVERSED INSERT",663962,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"TORNIER AEQUALIS SHOULDER REVERSED TRAY",663961,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"TORNIER AEQUALIS STANDARD GLENOSPHERE 36MM",663967,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15801.6,,,10587.07,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4424.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4230.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4424.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7900.8,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",14221.44,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4468.69,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4230.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4424.45,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",15011.52,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13431.36,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4424.45,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9480.96,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4315.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4230.09,15011.52,
"Tornier Cannulated COCR Standard Glenosphere, 36 mm",691464,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"Tornier Flex Shoulder Standard PTC humeral stem B 132.5? 70mm",691463,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"Tornier Flex Shoulder System PTC Humeral Stem",690907,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20275.2,,,13584.38,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5677.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5427.67,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5677.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10137.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18247.68,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5733.83,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5427.67,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5677.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19261.44,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17233.92,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5677.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12165.12,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5537.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5427.67,19261.44,
"Tornier Perfoem Reversed Glenoid Standard Baseplate",663964,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20000,,,13400,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5354,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18000,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5656,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5354,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5600,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19000,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17000,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5600,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5462,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5354,19000,
"Tornier Perform Reversed Central Screw 6.5mm x 30mm",691465,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2000,,,1340,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",535.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",565.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",535.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",560,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1900,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1700,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",546.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",535.4,1900,
"Tornier Perform Reversed Peripheral Screw 5.0mm x 18mm",691466,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2000,,,1340,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",535.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",565.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",535.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",560,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1900,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1700,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",546.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",535.4,1900,
"Tornier Perform Reversed Peripheral Screw 5.0mm x 26mm",691467,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2000,,,1340,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",535.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",565.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",535.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",560,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1900,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1700,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",560,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",546.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",535.4,1900,
"Trauma Team Activated",2G0390,CDM,684,RC,G0390,HCPCS,"OUTPATIENT ",,,3910,,,2619.7,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1094.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1046.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1094.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3519,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1105.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1046.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1094.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3714.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3323.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1094.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2346,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1067.82,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1046.71,3714.5,
"Treace 18x14mm SpeedPlate? Rapid Compression Implant",690886,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12144,,,8136.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3400.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3250.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3400.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6072,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10929.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3434.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3250.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3400.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11536.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10322.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3400.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7286.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3316.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3250.95,11536.8,
"Treace 18x17mm SpeedPlate? Rapid Compression Implant",690893,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,12144,,,8136.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3400.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3250.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3400.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6072,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10929.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3434.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3250.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3400.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11536.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10322.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3400.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7286.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3316.53,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3250.95,11536.8,
"Treace 2.7 mm x 12mm, 14mm FastPitch Locking Screw",690112,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1912,,,1281.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",511.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",956,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1720.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",540.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",511.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",535.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1816.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1625.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1147.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",522.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",511.84,1816.4,
"Treace 28x17x14mm SpeedPlate? Anatomic Quad Rapid Compression Implant",691135,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13048,,,8742.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3653.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3492.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3653.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6524,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11743.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3689.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3492.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3653.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12395.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11090.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3653.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7828.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3563.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3492.95,12395.6,
"Treace 3.5mm Lapiplasty Transverse screws",691181,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1912,,,1281.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",511.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",956,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1720.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",540.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",511.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",535.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1816.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1625.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1147.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",522.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",511.84,1816.4,
"Treace FastPitch 2.7mm High Pitch Locking Screws",690426,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1912,,,1281.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",511.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",956,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1720.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",540.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",511.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",535.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1816.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1625.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1147.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",522.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",511.84,1816.4,
"Treace Lapiplasty 4.0mm Interfrag Screw",691378,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1912,,,1281.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",511.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",956,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1720.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",540.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",511.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",535.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1816.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1625.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1147.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",522.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",511.84,1816.4,
"Treace Lapiplasty Lesser TMT Fixation Pack",690173,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8200,,,5494,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2296,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2195.14,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2296,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4100,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7380,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2318.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2195.14,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2296,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7790,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6970,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2296,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4920,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2239.42,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2195.14,7790,
"Treace Lapiplasty Speedplate Quad",690764,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13048,,,8742.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3653.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3492.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3653.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6524,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11743.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3689.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3492.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3653.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12395.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11090.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3653.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7828.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3563.41,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3492.95,12395.6,
"Treace Lapiplasty System",690111,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,18600,,,12462,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5208,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4979.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5208,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5260.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4979.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5208,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17670,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15810,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5208,28,,,,,0,"percent of total billed charges ","28% of total billed charges",11160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5079.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4979.22,17670,
"Treace Nanoplasty Bicortical Screw Pack",691293,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,17992,,,12054.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5037.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4816.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5037.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8996,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",16192.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5088.14,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4816.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5037.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",17092.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",15293.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5037.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",10795.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4913.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4816.46,17092.4,
"Treace SpeedAkin 9 x 9mm Anatomic Compression Implant",691216,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6752,,,4523.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1890.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1807.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1890.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3376,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6076.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1909.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1807.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1890.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6414.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5739.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1890.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4051.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1843.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1807.51,6414.4,
"Treace SpeedMTP 3.5mm Headless Screw",691349,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2364,,,1583.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",661.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",632.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",661.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1182,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2127.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",668.54,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",632.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",661.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2245.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2009.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",661.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1418.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",645.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",632.84,2245.8,
"Treace SpeedPlate Micro-Quad 14mm Implant",691295,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13948,,,9345.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3905.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3733.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3905.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6974,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12553.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3944.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3733.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3905.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13250.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11855.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3905.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8368.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3809.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3733.88,13250.6,
"Treace SpeedPlate Mirco-Quad 17mm Implant",691268,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13948,,,9345.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3905.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3733.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3905.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6974,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",12553.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3944.49,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3733.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3905.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",13250.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11855.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3905.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8368.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3809.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3733.88,13250.6,
"Treace Stryker Lapiplasty 2.0mm Snap-off Screw",690832,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1912,,,1281.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",511.84,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",956,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1720.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",540.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",511.84,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",535.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1816.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1625.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",535.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1147.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",522.17,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",511.84,1816.4,
"TRIATHLON ASYMETRIC PATELLA",663184,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4600,,,3082,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1288,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1231.42,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1288,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4140,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1300.88,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1231.42,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1288,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4370,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3910,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1288,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2760,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1256.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1231.42,4370,
"TRIATHLON POST STABILIZED FEMORAL",663183,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15000,,,10050,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4015.5,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13500,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4242,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4015.5,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4200,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14250,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12750,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4200,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9000,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4096.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4015.5,14250,
"TRIATHLON TIBIAL COMPONENT",663182,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,8000,,,5360,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2141.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7200,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2262.4,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2141.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2240,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7600,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6800,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2240,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4800,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2184.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2141.6,7600,
"TRIATHLON TIBIAL INSERT",663181,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,7000,,,4690,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1960,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1873.9,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1960,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6300,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1979.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1873.9,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1960,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6650,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5950,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1960,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1911.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1873.9,6650,
"TUBING IV CATH VALVE, LUER ACTIVATED IV1",5046034,CDM,270,RC,S1015,HCPCS,"OUTPATIENT ",,,3.69,,,2.47,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",0.99,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",3.32,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",0.99,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1.03,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3.14,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1.03,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2.21,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",0.99,3.51,
"Unattended Electrical Therapy Charge",4411445,CDM,430,RC,G0283,HCPCS,"OUTPATIENT ",,,156,,,104.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",41.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",140.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",41.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",43.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",148.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",132.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",43.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",93.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",42.6,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",41.76,148.2,
"Univers Revers? Modular Glenoid System 20mm Central Screw, Shoulder implant",691525,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,6336,,,4245.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1774.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1696.15,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1774.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3168,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5702.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1791.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1696.15,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1774.08,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6019.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5385.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1774.08,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3801.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1730.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1696.15,6019.2,
"VersaGraft Tendon 3.5mm x 220mm",691415,CDM,278,RC,C1763,HCPCS,"OUTPATIENT ",,,5320,,,3564.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1424.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2660,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4788,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1504.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1424.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1489.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5054,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4522,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3192,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1452.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1424.16,5054,
"VersaGraft Tendon 3.5mm x 230mm",691244,CDM,278,RC,C1763,HCPCS,"OUTPATIENT ",,,5320,,,3564.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1424.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2660,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4788,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1504.5,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1424.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1489.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5054,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4522,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1489.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3192,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1452.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1424.16,5054,
"VersaGraft Tendon 4.0-5.0mm x 230mm",690970,CDM,278,RC,C1763,HCPCS,"OUTPATIENT ",,,5944,,,3982.48,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1664.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1591.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1664.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2972,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5349.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1680.96,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1591.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1664.32,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5646.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5052.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1664.32,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3566.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1623.31,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1591.21,5646.8,
"Virtuos Lyograft Medium",690116,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,9900,,,6633,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2772,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2650.23,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2772,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4950,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8910,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2799.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2650.23,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2772,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",9405,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8415,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2772,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5940,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2703.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2650.23,9405,
"VIRTUOS LYOGRAFT SMALL",664820,CDM,278,RC,C9359,HCPCS,"OUTPATIENT ",,,2520,,,1688.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",705.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",674.6,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",705.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1260,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2268,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",712.66,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",674.6,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",705.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2394,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2142,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",705.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1512,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",688.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",674.6,2394,
"WM 101mm Right Lateral Fibula Plate",690898,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6964,,,4665.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1949.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1864.26,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1949.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3482,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6267.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1969.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1864.26,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1949.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6615.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5919.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1949.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4178.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1901.87,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1864.26,6615.8,
"WM 12 Hole Locking Plate",691232,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3456,,,2315.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",967.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",925.17,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",967.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1728,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3110.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",977.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",925.17,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",967.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3283.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2937.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",967.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2073.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",943.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",925.17,3283.2,
"WM 14 HOLE STRAIGHT PLATE",690377,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6400,,,4288,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1713.28,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5760,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1809.92,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1713.28,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1792,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6080,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5440,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1792,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3840,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1747.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1713.28,6080,
"WM 2.0 X 12mm Snap-off Screw",664232,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,996,,,667.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",278.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",266.63,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",278.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",996,100,,,,,0,"fee schedule","100% of total billed charges",896.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",281.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",266.63,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",278.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",946.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",846.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",278.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",597.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",272.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",266.63,996,
"WM 2.7 x 22mm Screw",690982,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM 2.7mm x 12mm Locking Screw",664231,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,916,,,613.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",245.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",916,100,,,,,0,"fee schedule","100% of total billed charges",824.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",259.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",245.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",256.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",870.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",778.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",549.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",250.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",245.21,916,
"WM 2.7mm x 16mm Locking Screw",691347,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,916,,,613.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",245.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",916,100,,,,,0,"fee schedule","100% of total billed charges",824.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",259.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",245.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",256.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",870.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",778.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",549.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",250.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",245.21,916,
"WM 25mm x 25mm Dynamic Compression Staple",690868,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7092,,,4751.64,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1985.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1898.53,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1985.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3546,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6382.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2005.62,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1898.53,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1985.76,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6737.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6028.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1985.76,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4255.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1936.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1898.53,6737.4,
"WM 3.5 x 12mm Low Profile Screw",664399,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM 3.5 x 14mm Locking Screw",690983,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,916,,,613.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",245.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",916,100,,,,,0,"fee schedule","100% of total billed charges",824.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",259.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",245.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",256.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",870.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",778.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",549.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",250.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",245.21,916,
"WM 3.5mm x 40mm Long Threaded Cannulated Screw",691665,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,673.92,,,451.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",188.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",180.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",188.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",673.92,100,,,,,0,"fee schedule","100% of total billed charges",606.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",190.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",180.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",188.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",640.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",572.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",188.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",404.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",184.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",180.41,673.92,
"WM 3.5mm x 42mm Long Threaded Cannulated Screw",691667,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,673.92,,,451.53,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",188.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",180.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",188.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",673.92,100,,,,,0,"fee schedule","100% of total billed charges",606.53,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",190.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",180.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",188.7,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",640.22,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",572.83,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",188.7,28,,,,,0,"percent of total billed charges ","28% of total billed charges",404.35,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",184.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",180.41,673.92,
"WM 3mm X 32mm MICA Screw",690751,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2548,,,1707.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",682.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1274,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2293.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",682.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",713.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2420.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2165.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1528.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",695.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",682.1,2420.6,
"WM 4.0 x 36mm Cannulated Screw",691231,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,704,,,471.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",188.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704,100,,,,,0,"fee schedule","100% of total billed charges",633.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",188.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",668.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",598.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",422.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",188.46,704,
"WM 4.0 x 38mm Cannulated Screw",664403,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,704,,,471.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",188.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704,100,,,,,0,"fee schedule","100% of total billed charges",633.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",188.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",668.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",598.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",422.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",188.46,704,
"WM 4.0 x 46mm Cannulated Screw",691460,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,760,,,509.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",212.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",203.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",212.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",760,100,,,,,0,"fee schedule","100% of total billed charges",684,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",214.93,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",203.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",212.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",722,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",646,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",212.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",456,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",207.56,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",203.45,760,
"WM 4.0 x 54mm screw",691235,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM 4.3mm X 46mm Cannulated Screw",691372,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1240,,,830.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",331.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",620,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1116,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",350.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",331.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",347.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1178,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1054,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",744,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",338.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",331.95,1178,
"WM 4.3mm x 60mm Cannulated Screw Long",690866,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1240,,,830.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",331.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",620,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1116,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",350.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",331.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",347.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1178,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1054,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",744,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",338.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",331.95,1178,
"WM 4.3MMX 42MM SHORT CANNULATED SCREW",690807,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1240,,,830.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",331.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",620,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1116,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",350.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",331.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",347.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1178,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1054,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",744,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",338.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",331.95,1178,
"WM 4.3MMX 44MM SHORT CANNULATED SCREW",690870,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1240,,,830.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",331.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",620,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1116,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",350.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",331.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",347.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1178,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1054,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",744,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",338.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",331.95,1178,
"WM 4mm X 38mm MICA Screw",690750,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2548,,,1707.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",682.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1274,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2293.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",682.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",713.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2420.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2165.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1528.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",695.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",682.1,2420.6,
"WM 5M 5? Left MTP Fusion Plate",691469,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6276,,,4204.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1757.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1680.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1757.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3138,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5648.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1774.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1680.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1757.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5962.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5334.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1757.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3765.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1713.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1680.09,5962.2,
"WM 6.5mm X 120mm BOLT",690662,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7828,,,5244.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2191.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2095.56,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2191.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3914,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7045.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2213.76,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2095.56,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2191.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7436.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6653.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2191.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4696.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2137.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2095.56,7436.6,
"WM 7.0 X 50mm Headless Screw",690997,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2240,,,1500.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2016,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",599.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",627.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2128,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1904,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",611.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",599.65,2128,
"WM 7.0 x 70mm Screw Short Thread",690177,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2240,,,1500.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2016,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",599.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",627.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2128,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1904,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",611.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",599.65,2128,
"WM 7.0mm X 55mm Healdless Screw",690658,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2240,,,1500.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2016,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",599.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",627.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2128,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1904,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",611.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",599.65,2128,
"WM 7.0mm X 75mm Healdless Screw",690175,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8088,,,5418.96,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2264.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2165.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2264.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4044,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7279.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2287.29,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2165.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2264.64,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7683.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6874.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2264.64,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4852.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2208.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2165.16,7683.6,
"WM 7.0mm X 75mm Healdless Screw",690179,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2240,,,1500.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2016,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",599.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",627.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2128,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1904,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",611.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",599.65,2128,
"WM 77mm Fibula Plate Right",691075,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6664,,,4464.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1865.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1783.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1865.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3332,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5997.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1884.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1783.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1865.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6330.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5664.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1865.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3998.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1819.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1783.95,6330.8,
"WM 89 mm Fibula Plate Left",690981,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6820,,,4569.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1909.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1825.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1909.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3410,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6138,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1928.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1825.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1909.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6479,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5797,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1909.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4092,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1862.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1825.71,6479,
"WM 89mm Right Fibula Plate",691151,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6820,,,4569.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1909.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1825.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1909.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3410,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",6138,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1928.7,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1825.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1909.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6479,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5797,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1909.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4092,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1862.54,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1825.71,6479,
"WM Augment Injectable Kit 3cc",664333,CDM,278,RC,C1734,HCPCS,"OUTPATIENT ",,,15513.12,,,10393.79,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4343.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4152.86,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4343.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7756.56,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13961.81,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4387.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4152.86,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4343.67,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14737.46,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13186.15,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4343.67,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9307.87,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4236.63,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4152.86,14737.46,
"WM CANNULATED SCREW 4.0 X 38MM",690352,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2456,,,1645.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",687.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",657.47,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",687.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1228,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2210.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",694.56,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",657.47,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",687.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2333.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2087.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",687.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1473.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",670.73,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",657.47,2333.2,
"WM CHARLOTTE QUICK STAPLE",663576,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1112,,,745.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",311.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",297.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",311.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",556,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1000.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",314.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",297.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",311.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1056.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",945.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",311.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",667.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",303.69,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",297.68,1056.4,
"WM CORTICAL SCREW 3.5 X 56MM",664400,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1048,,,702.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",524,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",943.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",280.55,995.6,
"WM CORTICAL SCREW 3.5 X 60MM",690128,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,968,,,648.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",271.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",259.13,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",271.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",968,100,,,,,0,"fee schedule","100% of total billed charges",871.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",273.75,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",259.13,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",271.04,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",919.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",822.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",271.04,28,,,,,0,"percent of total billed charges ","28% of total billed charges",580.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",264.36,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",259.13,968,
"WM CORTICAL SCREW FULL 3.5 X 54MM",690298,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1048,,,702.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",524,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",943.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",280.55,995.6,
"WM Darco 7.0mm X 80mm Headless Screw",690423,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2240,,,1500.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2016,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",599.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",627.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2128,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1904,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",611.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",599.65,2128,
"WM FIBULA PLATE 10 HOLE LOCKING",664397,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2856,,,1913.52,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",799.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",764.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",799.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1428,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2570.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",807.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",764.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",799.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2713.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2427.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",799.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1713.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",779.97,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",764.55,2713.2,
"WM FUSEFORCE NITINOL STAPLE KIT 15MM X 15MM",690806,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5048,,,3382.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1413.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1351.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1413.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2524,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4543.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1427.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1351.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1413.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4795.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4290.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1413.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3028.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1378.61,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1351.35,4795.6,
"WM Gravity Synchfix Gravity syndesmotic fixation device sterile  implant/instrument kit",690805,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4772,,,3197.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1336.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1277.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1336.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2386,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4294.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1349.52,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1277.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1336.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4533.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4056.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1336.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2863.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1303.23,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1277.46,4533.4,
"WM Headless screw 3mm x 26mm",691345,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,740,,,495.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",207.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",198.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",207.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",740,100,,,,,0,"fee schedule","100% of total billed charges",666,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",209.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",198.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",207.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",703,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",629,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",207.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",444,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",202.09,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",198.1,740,
"WM Headless Screw 7.0 x 60mm Short",690353,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2240,,,1500.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2016,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",599.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",627.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2128,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1904,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",611.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",599.65,2128,
"WM HEADLESS SCREW 7.0 X 65MM",690291,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2240,,,1500.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",599.65,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1120,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2016,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.47,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",599.65,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",627.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2128,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1904,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",627.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1344,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",611.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",599.65,2128,
"WM INBONE  Poly Insert Size:3 H: 8mm",691535,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15311.28,,,10258.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4098.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7655.64,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13780.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4330.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4098.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4287.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14545.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13014.59,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9186.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4181.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4098.83,14545.72,
"WM INBONE BONE REMOVAL SCREW",664044,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,1104,,,739.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",309.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",295.54,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",309.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",552,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",993.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",312.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",295.54,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",309.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1048.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",938.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",309.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",662.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",301.5,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",295.54,1048.8,
"WM INBONE EVERLAST Cross-linked Poly Insert Size 2+",691280,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,36342.92,,,24349.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9729,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18171.46,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",32708.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10277.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9729,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10176.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34525.77,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30891.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21805.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9925.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9729,34525.77,
"WM INBONE EVERLAST Cross-linked Poly Insert Size 4+",691211,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,22739.32,,,15235.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6087.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11369.66,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",20465.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6430.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6087.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6367.01,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",21602.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",19328.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges",13643.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6210.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6087.32,21602.35,
"WM Inbone Everlast Cross-Linked Poly Insert Size 4+, H: 14mm",691457,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,30710.56,,,20576.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8598.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8221.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8598.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15355.28,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",27639.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8684.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8221.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8598.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29175.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",26103.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8598.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18426.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8387.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8221.22,29175.03,
"WM INBONE EVERLAST Cross-linked Poly Insert size: 2+",691433,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,30710.56,,,20576.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",8598.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",8221.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",8598.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",15355.28,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",27639.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8684.95,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",8221.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",8598.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",29175.03,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",26103.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",8598.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",18426.34,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",8387.05,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",8221.22,29175.03,
"WM Inbone Everlast Cross-Linked Poly Insert, Size 2",691476,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,22739.32,,,15235.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6087.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11369.66,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",20465.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6430.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6087.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6367.01,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",21602.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",19328.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges",13643.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6210.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6087.32,21602.35,
"WM Inbone Everlast Cross-Linked Poly Insert, Size 3+, H: 10mm",691459,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,22739.32,,,15235.34,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6087.32,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11369.66,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",20465.39,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6430.68,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6087.32,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6367.01,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",21602.35,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",19328.42,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6367.01,28,,,,,0,"percent of total billed charges ","28% of total billed charges",13643.59,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6210.11,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6087.32,21602.35,
"WM Inbone Poly Insert size 1+ H:10mm",691500,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20676.72,,,13853.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5535.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10338.36,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18609.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5847.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5535.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5789.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19642.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17575.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12406.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5646.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5535.16,19642.88,
"WM Inbone Poly Insert size 1+ H:12mm",691523,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20676.72,,,13853.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5535.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10338.36,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18609.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5847.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5535.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5789.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19642.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17575.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12406.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5646.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5535.16,19642.88,
"WM INBONE Poly Insert Sulcus size 2",691117,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,14796,,,9913.32,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4142.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3960.89,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4142.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7398,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13316.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4184.31,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3960.89,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4142.88,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14056.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12576.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4142.88,28,,,,,0,"percent of total billed charges ","28% of total billed charges",8877.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4040.79,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3960.89,14056.2,
"WM Inbone Poly Insert Sulcus, size 3, H: 10mm",691642,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15311.28,,,10258.56,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4098.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7655.64,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13780.15,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4330.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4098.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4287.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14545.72,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13014.59,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4287.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9186.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4181.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4098.83,14545.72,
"WM Inbone Poly Insert Sulcus, size 3, H: 14mm",691664,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,20676.72,,,13853.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5535.16,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",10338.36,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",18609.05,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5847.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5535.16,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",5789.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",19642.88,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",17575.21,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",5789.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",12406.03,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",5646.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5535.16,19642.88,
"WM INBONE Talar Dome  size 4",664194,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,36342.92,,,24349.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9729,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18171.46,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",32708.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10277.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9729,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10176.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34525.77,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30891.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21805.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9925.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9729,34525.77,
"WM INBONE Talar Dome size 2",691116,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,36342.92,,,24349.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9729,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18171.46,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",32708.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10277.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9729,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10176.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34525.77,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30891.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21805.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9925.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9729,34525.77,
"WM Inbone Talar Dome, Size 1",691499,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,36342.92,,,24349.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9729,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18171.46,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",32708.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10277.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9729,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10176.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34525.77,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30891.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21805.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9925.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9729,34525.77,
"WM Inbone Talar Dome, Size 3",691458,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,36342.92,,,24349.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",9729,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",18171.46,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",32708.63,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10277.78,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",9729,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",10176.02,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",34525.77,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",30891.48,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",10176.02,28,,,,,0,"percent of total billed charges ","28% of total billed charges",21805.75,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",9925.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",9729,34525.77,
"WM INBONE Talar Stem 10mm",664195,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9170.08,,,6143.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2567.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2454.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2567.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4585.04,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8253.07,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2593.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2454.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2567.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8711.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7794.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2567.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5502.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2504.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2454.83,8711.58,
"WM INBONE Talar Stem 14mm",691432,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9170.08,,,6143.95,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2567.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2454.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2567.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4585.04,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8253.07,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2593.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2454.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2567.62,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8711.58,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7794.57,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2567.62,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5502.05,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2504.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2454.83,8711.58,
"WM INBONE Tibial Base Stem 16mm",691114,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4878.8,,,3268.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1366.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1306.05,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1366.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2439.4,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4390.92,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1379.72,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1306.05,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1366.06,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4634.86,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4146.98,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1366.06,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2927.28,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1332.4,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1306.05,4634.86,
"WM INBONE Tibial Md Stem 16mm",691209,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4778.2,,,3201.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1337.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1279.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1337.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2389.1,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4300.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1351.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1279.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1337.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4539.29,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4061.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1337.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2866.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1304.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1279.12,4539.29,
"WM INBONE Tibial Mid Stem 14mm",691113,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4778.2,,,3201.39,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1337.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1279.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1337.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2389.1,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4300.38,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1351.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1279.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1337.9,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4539.29,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4061.47,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1337.9,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2866.92,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1304.93,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1279.12,4539.29,
"WM INBONE Tibial Top Stem 14mm",691112,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4473.96,,,2997.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1252.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1197.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1252.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2236.98,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4026.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1265.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1197.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1252.71,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4250.26,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3802.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1252.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2684.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1221.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1197.68,4250.26,
"WM INBONE Tibial Tray, Left 3 Long",691431,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12008.96,,,8046,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3214.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6004.48,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10808.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3396.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3214.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3362.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11408.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10207.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7205.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3214.8,11408.51,
"WM INBONE Tibial Tray, Left size 2 long",691115,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12008.96,,,8046,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3214.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6004.48,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10808.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3396.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3214.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3362.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11408.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10207.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7205.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3214.8,11408.51,
"WM INBONE Tibial Tray, Left size 3",691279,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12008.96,,,8046,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3214.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6004.48,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10808.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3396.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3214.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3362.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11408.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10207.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7205.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3214.8,11408.51,
"WM Inbone Tibial Tray, Right 2 Long",691475,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12008.96,,,8046,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3214.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6004.48,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10808.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3396.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3214.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3362.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11408.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10207.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7205.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3214.8,11408.51,
"WM Inbone Tibial Tray, Right 3 Long",691536,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12008.96,,,8046,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3214.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6004.48,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10808.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3396.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3214.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3362.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11408.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10207.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7205.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3214.8,11408.51,
"WM Inbone TIbial Tray, Right 4 Long",664193,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12008.96,,,8046,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3214.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6004.48,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10808.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3396.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3214.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3362.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11408.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10207.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7205.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3214.8,11408.51,
"WM INBONE Tibial Tray, Right Size 5",691210,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,11504,,,7707.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3221.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3079.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3221.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5752,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10353.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3253.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3079.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3221.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10928.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9778.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3221.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6902.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3141.74,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3079.62,10928.8,
"WM Inbone Tibial Tray, Right, 5 Long",691456,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,12008.96,,,8046,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3214.8,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6004.48,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10808.06,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3396.13,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3214.8,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3362.51,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",11408.51,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",10207.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3362.51,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7205.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3279.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3214.8,11408.51,
"WM INFINITY EVERLAST CROSS-LINKED POLY INSERT SIZE 4, 6MM",690356,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,15176,,,10167.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4249.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4062.62,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4249.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7588,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",13658.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4291.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4062.62,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4249.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14417.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",12899.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4249.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9105.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4144.57,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4062.62,14417.2,
"WM INFINITY POLY INSERT",664042,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,9464,,,6340.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2649.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2533.51,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2649.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4732,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",8517.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2676.42,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2533.51,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2649.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8990.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",8044.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2649.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5678.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2584.62,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2533.51,8990.8,
"WM INFINITY TALAR DOME",664043,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,25316,,,16961.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",7088.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6777.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",7088.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12658,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",22784.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7159.36,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6777.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",7088.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",24050.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",21518.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",7088.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",15189.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6913.8,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6777.09,24050.2,
"WM INFINITY TIBIAL COMPONENT",664041,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,23848,,,15978.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6677.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6384.11,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6677.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11924,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",21463.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6744.21,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6384.11,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6677.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",22655.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",20270.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6677.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14308.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6512.89,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6384.11,22655.6,
"WM ISO MINI SCREW LOCKING 2.4MM",663688,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,628,,,420.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",168.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",628,100,,,,,0,"fee schedule","100% of total billed charges",565.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",168.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",175.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",596.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",533.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",376.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",171.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",168.12,628,
"WM ISO SCREW MINI NL 2.4MM",663687,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,628,,,420.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",168.12,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",628,100,,,,,0,"fee schedule","100% of total billed charges",565.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",168.12,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",175.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",596.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",533.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",175.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",376.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",171.51,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",168.12,628,
"WM LATERAL FIBULA PLATE LT 77MM",690595,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6664,,,4464.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1865.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1783.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1865.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3332,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5997.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1884.58,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1783.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1865.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",6330.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5664.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1865.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3998.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1819.94,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1783.95,6330.8,
"WM LOCKING SCREW 3.5 X 12MM",690596,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,916,,,613.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",245.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",916,100,,,,,0,"fee schedule","100% of total billed charges",824.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",259.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",245.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",256.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",870.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",778.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",549.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",250.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",245.21,916,
"WM LOCKING SCREW 3.5 X 16MM",690125,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,916,,,613.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",245.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",916,100,,,,,0,"fee schedule","100% of total billed charges",824.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",259.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",245.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",256.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",870.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",778.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",549.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",250.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",245.21,916,
"WM LOCKING SCREW 3.5 X 18MM",690900,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,916,,,613.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",245.21,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",916,100,,,,,0,"fee schedule","100% of total billed charges",824.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",259.04,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",245.21,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",256.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",870.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",778.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",256.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",549.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",250.16,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",245.21,916,
"WM LONG THREAD HEADLESS SCREW 4.3 X 50MM",690293,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1240,,,830.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",331.95,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",620,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1116,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",350.67,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",331.95,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",347.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1178,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1054,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",347.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",744,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",338.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",331.95,1178,
"WM LONG THREAD HEADLESS SCREW 4.3 X 55MM",690354,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3240,,,2170.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",867.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1620,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2916,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",916.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",867.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",907.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3078,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2754,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1944,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",884.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",867.35,3078,
"WM LOW-PRO CORT SCREW 3.5 X 10MM",690597,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM LOW-PRO CORT SCREW 3.5 X 18MM",690379,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM LOW-PRO CORT SCREW 3.5 X 20MM",690378,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1048,,,702.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",524,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",943.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",280.55,995.6,
"WM LOW-PRO CORT SCREW 3.5 X 22MM",690899,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM LOW-PRO CORT SCREW 3.5 X 60MM",690380,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1048,,,702.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",280.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",524,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",943.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.37,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",280.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",293.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",995.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",890.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",293.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",628.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",286.21,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",280.55,995.6,
"WM MTP Fusion, Small 0? Plate, Left",691346,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6276,,,4204.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1757.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1680.09,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1757.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3138,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5648.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1774.85,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1680.09,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1757.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5962.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5334.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1757.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3765.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1713.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1680.09,5962.2,
"WM NON-LOCKING LG HD SCREW 2.7 X 14MM",690803,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM NON-LOCKING SCREW 2.7 X 26MM",690598,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM Non-Locking Screw 2.7mm x 16mm",691233,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM Non-locking Screw 2.7mm x 20mm",691083,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM NONLOCKING SCREW 3.5 X 16MM",690127,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM OFFSET LOCKING PLATE 4 HOLE",690295,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3924,,,2629.08,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1098.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1050.45,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1098.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1962,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3531.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1109.71,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1050.45,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1098.72,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3727.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3335.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1098.72,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2354.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1071.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1050.45,3727.8,
"WM ORTHOLOC SCREW NON LOCK 2.0",66389,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,620,,,415.4,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",165.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",620,100,,,,,0,"fee schedule","100% of total billed charges",558,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.34,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",165.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",173.6,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",589,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",527,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",173.6,28,,,,,0,"percent of total billed charges ","28% of total billed charges",372,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",169.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",165.97,620,
"WM PLATE CROSSCHECK LAPIDUS",663996,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,13204,,,8846.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3697.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3534.71,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3697.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6602,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",11883.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3734.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3534.71,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3697.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",12543.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",11223.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3697.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",7922.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3606.01,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3534.71,12543.8,
"WM PLATE ISO (BUNION)",663686,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,6312,,,4229.04,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1767.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1689.72,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1767.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3156,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",5680.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1785.03,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1689.72,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1767.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5996.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",5365.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1767.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3787.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1723.81,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1689.72,5996.4,
"WM PLATE MAXLOCK TMT",663889,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,7848,,,5258.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2197.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2100.91,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2197.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3924,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7063.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2219.41,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2100.91,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2197.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",7455.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",6670.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2197.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",4708.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2143.29,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2100.91,7455.6,
"WM PLATE ORTHOLOC UNIV ANT FUSION",663968,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,15704,,,10521.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",4397.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4203.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",4397.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",7852,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",14133.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4441.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",4203.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",4397.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",14918.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",13348.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",4397.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",9422.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",4288.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",4203.96,14918.8,
"WM PROSTEP MICA SCREW 3mm x 20mm",690824,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2548,,,1707.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",682.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1274,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2293.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",682.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",713.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2420.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2165.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1528.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",695.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",682.1,2420.6,
"WM PROstep? MICA? SCREW 3.0MM X 24MM",690923,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2548,,,1707.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",682.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1274,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2293.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",682.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",713.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2420.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2165.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1528.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",695.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",682.1,2420.6,
"WM PROstep? MICA? SCREW 3.0MM X 30MM",664062,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4176,,,2797.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1169.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1117.92,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1169.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2088,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3758.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1180.97,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1117.92,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1169.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3967.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3549.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1169.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2505.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1140.47,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1117.92,3967.2,
"WM PROstep? MICA? SCREW 3.0MM X 40MM",690922,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2548,,,1707.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",682.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1274,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2293.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",682.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",713.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2420.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2165.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1528.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",695.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",682.1,2420.6,
"WM PROstep? MICA? SCREW 4.0MM X 50MM",664061,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2548,,,1707.16,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",682.1,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1274,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2293.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.57,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",682.1,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",713.44,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2420.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2165.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",713.44,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1528.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",695.86,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",682.1,2420.6,
"WM SALVATION BOLT 5.0 X 115MM",690538,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,10772,,,7217.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3016.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2883.66,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3016.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5386,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",9694.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3046.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2883.66,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3016.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10233.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9156.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3016.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6463.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2941.83,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2883.66,10233.4,
"WM SALVATION BOLT 6.5 X 110MM",690537,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,11564,,,7747.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",3237.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",3095.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",3237.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5782,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",10407.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3270.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",3095.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",3237.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",10985.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",9829.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",3237.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",6938.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",3158.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",3095.68,10985.8,
"WM SCREW 3.5MM LOCK",663144,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1380,,,924.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",386.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",369.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",386.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",690,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1242,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",390.26,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",369.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",386.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1311,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1173,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",386.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",828,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",376.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",369.43,1311,
"WM SCREW 4.0 X 40MM CANNULATED",690804,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,704,,,471.68,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",188.46,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",704,100,,,,,0,"fee schedule","100% of total billed charges",633.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",188.46,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",197.12,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",668.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",598.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",197.12,28,,,,,0,"percent of total billed charges ","28% of total billed charges",422.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",192.26,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",188.46,704,
"WM SCREW CHARLOTTE 3.0 MUC",663888,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1716,,,1149.72,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",480.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",459.37,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",480.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",858,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1544.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",485.28,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",459.37,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",480.48,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1630.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1458.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",480.48,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1029.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",468.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",459.37,1630.2,
"WM SCREW CHARLOTTE 7.0 MUC",663876,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5528,,,3703.76,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1547.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1479.85,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1547.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2764,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4975.2,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1563.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1479.85,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1547.84,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5251.6,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4698.8,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1547.84,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3316.8,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1509.7,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1479.85,5251.6,
"WM SCREW HEADED CANN  4.0",663915,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1832,,,1227.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",512.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",490.43,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",512.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",916,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1648.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",518.09,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",490.43,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",512.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1740.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1557.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",512.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1099.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",500.32,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",490.43,1740.4,
"WM SCREW LAG 3.5",663997,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1776,,,1189.92,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",497.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",475.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",497.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",888,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1598.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",502.25,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",475.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",497.28,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1687.2,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1509.6,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",497.28,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1065.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",485.03,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",475.44,1687.2,
"WM SCREW LOW PROFILE 3.5 X 14MM",690314,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM SCREW LOW PROFILE 3.5 X 55MM",690315,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,472,,,316.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",126.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",472,100,,,,,0,"fee schedule","100% of total billed charges",424.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.48,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",126.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",132.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",448.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",401.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",132.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",283.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",128.9,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",126.35,472,
"WM SCREW MAXLOCK 3.5MM LOCK",663890,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1072,,,718.24,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",300.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",286.97,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",300.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",536,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",964.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.16,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",286.97,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",300.16,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1018.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",911.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",300.16,28,,,,,0,"percent of total billed charges ","28% of total billed charges",643.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",292.76,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",286.97,1018.4,
"WM SCREW ORTHOLOC ANKLE FUSION 5.5 LOCK",663970,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1564,,,1047.88,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",437.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",418.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",437.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",782,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1407.6,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",442.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",418.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",437.92,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1485.8,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1329.4,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",437.92,28,,,,,0,"percent of total billed charges ","28% of total billed charges",938.4,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",427.13,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",418.68,1485.8,
"WM SCREW ORTHOLOC ANKLE FUSION 5.5 NL",663969,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,660,,,442.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",184.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",176.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",184.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",660,100,,,,,0,"fee schedule","100% of total billed charges",594,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",186.65,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",176.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",184.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",627,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",561,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",184.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",396,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",180.25,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",176.68,660,
"WM SCREW RAYHACK 2.7/3.5 MM NL",663978,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,552,,,369.84,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",147.77,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",552,100,,,,,0,"fee schedule","100% of total billed charges",496.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.11,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",147.77,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",154.56,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",524.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",469.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",154.56,28,,,,,0,"percent of total billed charges ","28% of total billed charges",331.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",150.75,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",147.77,552,
"WM SCREW RAYHACK 2.7MM  LOCK",663979,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1060,,,710.2,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",283.76,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",530,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",954,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",299.77,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",283.76,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",296.8,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1007,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",901,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",296.8,28,,,,,0,"percent of total billed charges ","28% of total billed charges",636,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",289.49,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",283.76,1007,
"WM SCREW SHORT THREAD 4.0 X 48",690176,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3240,,,2170.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",867.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1620,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2916,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",916.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",867.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",907.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3078,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2754,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1944,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",884.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",867.35,3078,
"WM SHORT THREAD HEADLESS SCREW 4.3 X 46MM",690294,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3240,,,2170.8,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",867.35,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1620,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2916,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",916.27,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",867.35,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",907.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",3078,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2754,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",907.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1944,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",884.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",867.35,3078,
"WM SYNDESMOSIS PLATE",690124,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,3132,,,2098.44,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",876.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",838.44,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",876.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1566,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2818.8,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",885.73,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",838.44,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",876.96,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2975.4,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2662.2,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",876.96,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1879.2,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",855.35,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",838.44,2975.4,
"WM TIbial Base Stem 18mm",664199,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4876.28,,,3267.11,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1365.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1305.38,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1365.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2438.14,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4388.65,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1379.01,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1305.38,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1365.36,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4632.47,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4144.84,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1365.36,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2925.77,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1331.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1305.38,4632.47,
"WM Tibial Top Stem 16mm",664197,CDM,278,RC,C1776,HCPCS,"OUTPATIENT ",,,4473.96,,,2997.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1252.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1197.68,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1252.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2236.98,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4026.56,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1265.24,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1197.68,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1252.71,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4250.26,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3802.87,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1252.71,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2684.38,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1221.84,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1197.68,4250.26,
"Xtant 32mm Locking Plate, no insert",691430,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"Xtant 36, 8mm Axle-X Locking Plate",691218,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"Xtant 36mm Axle-X Crossbar Plate",691217,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"Xtant 40, 8mm Axle-X Lock Plate",690963,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"XTANT AXEL-X CROSSBAR PLATE 32MM",690118,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT AXEL-X CROSSBAR PLATE 40MM",690246,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT AXEL-X LOCK PLATE 32, 8MM",690119,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT AXEL-X LOCK PLATE 40MM, 10MM",690247,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT AXLELOCK PLT W/ PEEK INSERT",663763,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,22000,,,14740,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6160,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",5889.4,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6160,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",11000,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",19800,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6221.6,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",5889.4,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6160,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",20900,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",18700,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6160,28,,,,,0,"percent of total billed charges ","28% of total billed charges",13200,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6008.2,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",5889.4,20900,
"XTANT CROSS BAR PLATE 36MM",690229,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"Xtant Cross Bar Plate 40mm",664256,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT LOCKING PLATE 12MM",690120,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT LOCKING PLATE 16MM",690142,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT LOCKING PLATE 36MM 10MM",690449,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT LOCKING PLATE 36MM 8MM",690230,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT LOCKING PLATE 40MM 10MM",690231,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"Xtant Locking Plate 40mm x 18mm",691424,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"Xtant Locking Plate 40mm x 8mm",690144,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT LOCKING PLATE 40mm, 14mm",664257,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,8600,,,5762,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2302.22,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",4300,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",7740,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2432.08,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",2302.22,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",2408,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",8170,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",7310,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",2408,28,,,,,0,"percent of total billed charges ","28% of total billed charges",5160,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",2348.66,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",2302.22,8170,
"XTANT OSTEOSELECT PUTTY 1.0CC",663895,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,680,,,455.6,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",190.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",182.04,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",190.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",680,100,,,,,0,"fee schedule","100% of total billed charges",612,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",192.3,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",182.04,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",190.4,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",646,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",578,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",190.4,28,,,,,0,"percent of total billed charges ","28% of total billed charges",408,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",185.71,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",182.04,680,
"XTANT OSTEOSELECT PUTTY 5.0CC",663881,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,2465,,,1651.55,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",690.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",659.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",690.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1232.5,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",2218.5,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",697.1,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",659.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",690.2,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",2341.75,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",2095.25,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",690.2,28,,,,,0,"percent of total billed charges ","28% of total billed charges",1479,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",673.19,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",659.88,2341.75,
"XTANT PEEK INSERT 10MM",690232,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"XTANT PEEK INSERT 12MM",690123,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"XTANT PEEK INSERT 14MM",690723,CDM,272,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",,,,,,,0,other,"not separately reimburment ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"XTANT PEEK INSERT 16MM",690143,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"Xtant Peek Insert 18mm",691425,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"Xtant Peek Insert 8mm",664258,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"Z MEDICAL Z STAPLE 8MM",690600,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4400,,,2948,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1177.88,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2200,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",3960,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.32,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1177.88,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1232,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4180,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",3740,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1232,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2640,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1201.64,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1177.88,4180,
"ZB CERVICAL DISC MOBI-C",663834,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,24800,,,16616,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",6944,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",6638.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",6944,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",12400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",22320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7013.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",6638.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",6944,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",23560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",21080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",6944,28,,,,,0,"percent of total billed charges ","28% of total billed charges",14880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",6772.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",6638.96,23560,
"ZB CERVICAL PLT ANT MAXAN 1-LVL",663839,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,4800,,,3216,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1284.96,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2400,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4320,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1357.44,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1284.96,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1344,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",4560,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4080,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1344,28,,,,,0,"percent of total billed charges ","28% of total billed charges",2880,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1310.88,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1284.96,4560,
"ZB JuggerStitch Meniscal Device Curved Implant",690939,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1500,,,1005,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",401.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",750,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",1350,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",424.2,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",401.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",420,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",1425,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",1275,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",420,28,,,,,0,"percent of total billed charges ","28% of total billed charges",900,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",409.65,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",401.55,1425,
"ZB PLATE STRAIGHT 4 HOLE",664511,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5406,,,3622.02,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1513.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1447.19,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1513.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2703,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4865.4,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1528.82,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1447.19,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1513.68,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",5135.7,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4595.1,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1513.68,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3243.6,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1476.38,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1447.19,5135.7,
"ZB SCREW MAXAN VARI 4.0",663840,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,1000,,,670,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",267.7,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",500,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",900,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.8,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",267.7,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",280,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",950,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",850,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",280,28,,,,,0,"percent of total billed charges ","28% of total billed charges",600,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",273.1,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",267.7,950,
"ZB STRATUM LOCKING SCREW 3.5 X 16MM",690189,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,850,,,569.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",227.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850,100,,,,,0,"fee schedule","100% of total billed charges",765,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",227.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",238,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",807.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",722.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges",510,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",232.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",227.55,850,
"ZB STRATUM LOCKING SCREW 3.5 X 20MM",664212,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,850,,,569.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",227.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850,100,,,,,0,"fee schedule","100% of total billed charges",765,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",227.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",238,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",807.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",722.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges",510,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",232.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",227.55,850,
"ZB STRATUM Locking Screw 3.5x10mm",691107,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,576.8,,,386.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",154.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",576.8,100,,,,,0,"fee schedule","100% of total billed charges",519.12,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",163.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",154.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",161.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",547.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",490.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",346.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",157.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",154.41,576.8,
"ZB STRATUM Locking Screw 3.5x18mm",691105,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,576.8,,,386.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",154.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",576.8,100,,,,,0,"fee schedule","100% of total billed charges",519.12,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",163.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",154.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",161.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",547.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",490.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",346.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",157.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",154.41,576.8,
"ZB STRATUM NONLOCKING LOW PROFILE SCREW 3.5 X 14MM",690190,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,850,,,569.5,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",227.55,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",850,100,,,,,0,"fee schedule","100% of total billed charges",765,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.38,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",227.55,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",238,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",807.5,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",722.5,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",238,28,,,,,0,"percent of total billed charges ","28% of total billed charges",510,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",232.14,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",227.55,850,
"ZB STRATUM Non-Locking Low-Profile Screw 3.5x12mm",691108,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,576.8,,,386.46,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",154.41,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",576.8,100,,,,,0,"fee schedule","100% of total billed charges",519.12,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",163.12,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",154.41,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",161.5,0.28,,,,,0,"percent of total billed charges","28% of total billed charges ",547.96,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",490.28,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",161.5,28,,,,,0,"percent of total billed charges ","28% of total billed charges",346.08,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",157.52,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",154.41,576.8,
"ZB STRATUM Single Lisfranc Plate - 2 Hole",691106,CDM,278,RC,C1713,HCPCS,"OUTPATIENT ",,,5397.2,,,3616.12,67,,,,,0,"percent of total billed charges  ","67% of total billed charges ",1511.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",1444.83,,,100.00,,,0,"fee schedule","100% of AR Medicaid fee Schedule ",1511.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges ",2698.6,50,,,,,0,"percent of total billed charges ","50% of total billed charges ",4857.48,90,,,,,0,"percent of total billed charges ","90% of otal billed charges ",,,,,,,0,,"not separately reimbursment ",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1526.33,28.28,,,,,0,"percent of total billed charges ","28.28% of total total billed charges ",1444.83,26.77,,,,,0,"percent of total billed charges ","26.77% of total billed charges",1511.22,28,,,,,0,"percent of total billed charges","28% of total billed charges ",5127.34,95,,,,,0,"percent of total billed charges ","95% of total billed charges ",,,,,,,0,other,"not separately reimbursment",4587.62,85,,,,,0,"percent of total billed charges ","85% of the total billed charges ",,,,,,,0,other,"not separately reimbursment",1511.22,28,,,,,0,"percent of total billed charges ","28% of total billed charges",3238.32,60,,,,,0,"percent of total billed charges ","60% percent f total billed charges ",1473.98,27.31,,,,,0,"percent of total billed charges ","27.31% of total billed charges ",1444.83,5127.34,